Presenting a case of a mucinous adenocarcinoma of an exstrophic bladder in an adult patient and a review of literature.

BACKGROUND: Bladder exstrophy occurs in approximately 1 in 35,000 live births and is associated with an increased incidence of bladder cancer. CASE PRESENTATION: A 55-year old male patient was diagnosed with a primary mucinous adenocarcinoma of an unreconstructed exstrophic bladder. Examination of the entire gastrointestinal tract shown there were not other primary cites. Immunohistochemistry confirmed the nature of the tumour. The patient underwent a radical cystoprostatectomy with en block bilateral pelvic lymphadenectomy, urinary diversion with a cutaneous ureterostomy and epidpadias repair. CONCLUSION: Adult bladder exstrophy and epispadia correction is a very rare practice in urology due the fact that this congenital disease is diagnosed and corrected in neonates. We advocate the radical surgical management, after exclusion of any primary malignant sites related to the gastrointestinal tract.

Ejaculation Sparing Thulium Laser Enucleation of the Prostate: An Observational Prospective Study.

Benign prostatic hypertrophy (BPH) is a condition that appears with advancing age and affects 1/3 of men over 50 years, resulting in filling and emptying symptoms. One of the main limitations of endoscopic techniques for BPH is the occurrence of retrograde ejaculation. The purpose of this prospective observational study is to evaluate the efficacy and feasibility of ejaculation-sparing thulium laser enucleation of the prostate (ES-ThuLEP) in the treatment of BPH-related LUTS and the preservation of ejaculation. Sexually active patients with BPH were enrolled and followed up with at 3, 6, and 12 months after surgery. Personal and pharmacological histories were collected, while three standardized questionnaires­the International Index of Erectile Function short form (IIEF-5), the International Consultation on Incontinence Questionnaire for Male Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ­MLUTSsex), and the International Prostatic Symptom Score (IPSS)­were administered. In addition, all patients underwent uroflowmetry and an assessment of post-void residual volume (PVR). A total of 53 patients were enrolled. A statistically significant improvement in the IPSS score, maximum flow (Qmax), and post-void volume (PVR) at 3 months, 6 months, and 12 months after surgery was found (p < 0.05), while no statistically significant differences were reported between IIEF-5 scores before and after surgery. A total of 48 patients (88.6%) had preserved ejaculation at 3 months, while 92.4% and 94.3% of patients reported preserved ejaculation at 6 and 12 months, respectively. Nevertheless, some degree of hypoposia was referred, at 3, 6, and 12 months, by 43.7%, 30.6%, and 13.2% of patients, respectively. The ES-ThuLEP technique successfully preserved ejaculation in over 90% of patients, representing an ejaculation-sparing alternative in the treatment of BPH.

A phytotherapic approach to reduce sperm DNA fragmentation in patients with male infertility.

INTRODUCTION: Infertility affects 50 to 80 million (between 8 and 12% of couples). Male factor is a cause of infertility in almost half of the cases, mainly due to oligoasthenoteratozoospermia. DNA fragmentation is now considered an important factor in the aetiology of male infertility. We studied the effects on semen analysis and on DNA fragmentation of in vivo admnistration of Myo-Inositol and Tribulus Terrestris plus Alga Ecklonia plus Biovis (Tradafertil; Tradapharma Sagl, Swizerland) in men with previously diagnosed male infertility. MATERIALS AND METHODS: Sixty patients were enrolled in the present study and were randomized into two subgroups: the group A who received Myo-inositol 1000 mg, Tribulus Terrestris 300 mg, Alga Ecklonia Bicyclis 200 mg and Biovis one tablet a day for 90 days, and the group B (placebo group) who received one placebo tablet a day for 90 days. The primary efficacy outcome was the improvement of semen characteristics after 3 months' therapy and the secondary outcome was the reduction of the DNA fragmentation after treatment. RESULTS: The groups were homogenous for age, hormonal levels, sperm concentration and all parameters of sperm analysis. Sperm concentration and progressive motility improved after treatment with Tradafertil (3.82 Mil/ml vs. 1.71 Mil/ml; p<0.05; 4.86% vs. 1.00%; p<0.05) as well as the DNA fragmentation (-1.64% vs -0.39%, p<0.001). No side effects were revealed. CONCLUSIONS: In conclusion, we can affirm that Tradafertil is safe and tolerable. It is a new phytotherapic approach to Oligoasthenoteratospermia (OAT) syndrome that could lead to good results without interacting with hypothalamic-pituitary-gonadal axis.

Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience.

PURPOSE: To evaluate the efficacy of the addition of tamsulosin to our standard expulsive pharmacologic therapy for the treatment of distal-ureteral stones. PATIENTS AND METHODS: A series of 96 patients referred to our department for the management of symptomatic distal-ureteral calculi were randomly divided into group 1 (N = 46) who received diclofenac (100 mg/daily) plus aescin (80 mg/daily) and group 2 (N = 50) who received the same therapy plus tamsulosin (0.4 mg/daily) for a maximum of 2 weeks. There were no differences between the groups with respect to age, sex, or stone size. The primary endpoint was the expulsion rate. Expulsion time, need for analgesics, need for hospitalization, and drug side effects were the secondary endpoints. RESULTS: The expulsion rate was significantly higher in group 2 (90%) than in group 1 (58.7%; P = 0.01), and group 2 achieved stone passage in a shorter time (mean 4.4 v 7.5 days, respectively; P = 0.005). Lower analgesic use was found in group 2 (P = 0.003), as well as significantly fewer hospitalizations for recurrent colic (P = 0.01). Both groups experienced few side effects associated with expulsive therapy. CONCLUSIONS: A conservative approach should be considered as an option in the management of uncomplicated distal-ureteral stones. Even if the best pharmacologic expulsive regimen remains to be established, the use of the selective alpha-blocker tamsulosin is recommended in this setting.

The forgotten stent: late complication in a patient with neobladder.

Encrustation constitutes a serious complication of ureteral stent use and can result in difficult stent removal. We report the case of a patient with a retained ureteral stent for 3 years following a radical cystectomy.

Orbital metastasis as a first indication of prostate cancer: a case report.

Prostatic carcinoma accounts for only 3.6% of orbital metastases encountered in clinical practice. We report the clinical presentation and response to treatment of a patient with metastatic prostatic carcinoma to the sella turcica. A 73-year-old man presented with a three-months history of progressive right proptosis associated with increasing diplopia in down-gaze and slightly decreased visual acuity. Gadolinium-MRI scans of the head revealed a left osteoblastic intrasellar mass, displacing the pituitary gland. Laboratory testing revealed a serum PSA level of 22 ng/ml. Transrectal ultrasound-guided biopsy revealed prostatic adenocarcinoma (Gleason score 4+3) in both lobes of the prostate. A bone scan was performed showing that the patient had multiple secondary bony lesions. Total androgen blockade was initiated. Moreover, he was referred for radiotherapy of this metastatic lesion to the sella turcica. The visual complaints regressed dramatically within the first month of the treatment. A follow-up MRI scan at 6 months showed almost complete involution of the orbital metastatic process. However the disease subsequently progressed and the patient died 22 months after diagnosis.

Effects of a moderate-intensity aerobic program on blood viscosity, platelet aggregation and fibrinolytic balance in young and middle-aged sedentary subjects.

Regular physical activity is associated with reduced risk of cardiovascular disease although the mechanisms are unclear. Recent population-based studies suggest that the effect of physical activity may be at least partly a result of action on hemostasis. We tested the hypothesis that moderate-intensity aerobic training improves fibrinolytic activity and reduces platelet aggregation and blood viscosity. In 15 young (11 males and four females; age, 24-32 years) and 15 middle-aged (11 males and four females; age, 45-65 years) healthy, non-smoker, sedentary subjects, the maximum oxygen consumption, adenosine diphosphate-induced platelet aggregation, tissue plasminogen activator and plasminogen activator inhibitor type 1, antigen, hematocrit and blood viscosity were measured at baseline and after 12 weeks of aerobic exercise training (40 min three times a week at a training intensity adjusted to 60% of the individual heart rate reserve). After training, the maximum oxygen consumption was increased by 9% (P < 0.01) in the young group and by 7.3% (P < 0.05) in the middle-aged group. Adenosine diphosphate-platelet aggregation significantly decreased in the young (-30%; P < 0.05). The middle-aged group showed a 10.4% decrease in hematocrit (P < 0.05), and a 11.6 and 16.6% decrease in blood viscosity at 450/s and at 90/s rates of shear, respectively (P < 0.05), while the plasminogen activator inhibitor type 1 antigen plasma level increased 135% (P < 0.01). These data, some not consistent with others, only partially support the hypothesis that the beneficial effects of physical activity result from action on hemostatic balance. In particular, the changes in the fibrinolytic system in middle-aged subjects might suggest increased thrombotic risk. Thus a simple, straightforward conclusion is not possible at present, and further studies are required.

Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial.

OBJECTIVES: To compare operative time, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus prone position in a prospective randomized trial. MATERIAL AND METHODS: From October 2005 to June 2007, 75 patients (33 men, 42 women; mean age, 39.3 yr) were prospectively enrolled and randomly divided into group A (39 patients, supine position) and group B (36 patients, prone position). Inclusion criteria were diagnosis of single or multiple renal stones (pelvic-caliceal) treatable with a single percutaneous access, stone diameter >2.5cm, body mass index (BMI) <30kg/m(2), and no contraindications to perform the operation in the prone position. Exclusion criteria were stones in more than one calyx, complete staghorn stones, and coexisting renal anomalies. RESULTS: The two groups were comparable in age, BMI, male-to-female ratio, and stone size. No significant difference was ascertained between the two groups in terms of stone-free rate (group A, 88.7% vs. group B, 91.6%, p=0.12), mean blood loss (group A, Delta hemoglobin -2.3g/dl vs. group B, -2.2g/dl, p=0.23), and mean hospital stay (group A, 4.3 d vs. group B, 4.1 d, p=0.18). The only significant difference reported was mean operative time (group A, 43min vs. group B, 68min, p<0.001). No blood transfusions were needed and no organ injuries were reported. CONCLUSIONS: In this carefully selected patient population with uncomplicated renal stones, the supine position was similar to the prone position for percutaneous stone removal.

What happens to the abstracts presented at the Societè Internationale d'Urologie meeting?

OBJECTIVES: To estimate the acceptance rate on peer-reviewed journals, describe the time-course of subsequent full publication, and identify those with characteristics associated with publication from the abstracts presented at the Societè Internationale d'Urologie (SIU) meeting. METHODS: All abstracts accepted for presentation at the annual 2002 and 2004 SIU meetings were identified from the published supplements in the BJU International. The subsequent publication rate for the corresponding studies by scanning Medline was evaluated. RESULTS: Overall, 1877 abstracts were presented, 415 of which (22.1%) were followed by publication in peer-reviewed journals. The mean time to publication was 13 months (range, 1 to 45 months). A total of 60.6% of the published articles were in print within 1 year of presentation "In most of the cases the reports were published in The Journal of Urology (76 reports) and in Urology (49 reports). Abstracts on kidney cancer, urinary diversion, incontinence, and urolithiasis had the highest publication rates (43.4%, 36.6%, 33.3%, and 29.2%, respectively). Studies from North America and from Oceania had the highest publication rate (26.8% and 26.6%, respectively). CONCLUSIONS: One fifth of the abstracts presented at the SIU meetings are ultimately published in indexed journals. Delegates attending these meetings should be aware of this issue when taking into account findings from meeting reports for their clinical practice. Factors influencing their publication are the abstract geographical area of origin, the study subject, and the research type. The Journal of Urology and Urology represented target journals for the publication more than other ones.

A new transportable shock-wave lithotripsy machine for managing urinary stones: a single-centre experience with a dual-focus lithotripter.

OBJECTIVE: To assess the efficacy and safety of a transportable extracorporeal shock wave lithotripsy (ESWL) machine, the Modulith SLX-F2(TM) (Storz Medical Italia, Rome, Italy), in the management of solitary urinary calculi. PATIENTS AND METHODS: The study included 233 patients (mean age 51 years; 172 male, 61 female) with symptomatic solitary renal (group A, 170, mean diameter 15.5 mm) or ureteric stones (group B, 63, mean diameter 9.5 mm) treated in a tertiary care institution. Exclusion criteria for the analysis were: pelvi-ureteric junction obstruction, multiple stones, stone diameter >2 cm, stones in a lower calyx with unfavourable anatomy, active infection, or impacted ureteric stones. Selected patients had ureteric stenting before treatment, and all patients were treated with no anaesthesia. Hospitalization, complications and subsequent auxiliary procedures were evaluated. Patients were assessed after a single ESWL session and after 3 months by a plain abdominal film and renal ultrasonography. Stone-free status was defined as no evidence of calculi, and clinical success as the presence of stone fragments of <4 mm. An efficiency quotient (EQ) was calculated for the ESWL treatment. Pain was assessed using a visual analogue scale. RESULTS: The mean number of shocks used was 3779 and the mean (range) treatment time was 35 (5-55) min. The overall clinical success rate after one ESWL session was 83.7% and 82.5% for renal and ureteric stones, respectively, and the overall 3-month stone-free rate was 77% and 74.6%, respectively; the overall EQ was 0.64. When risk factors for persistent calculi were analysed simultaneously in a logistic regression model, only stones of >1 cm were statistically significant (P < 0.05). Most patients reported that pain during ESWL was mild to moderate and easily tolerated. Only minor complications occurred, with an overall complication rate of 3.8%. CONCLUSIONS: This transportable lithotripter is a safe and effective device for managing solitary stones throughout the urinary tract. Its main advantage is represented by the dual-focus system. Moreover, it shares with other contemporary machines several important features such as outpatient setting, no need for anaesthesia, easy patient positioning, and the capability of ancillary procedures.

Gyrus bipolar versus standard monopolar transurethral resection of the prostate: a randomized prospective trial.

OBJECTIVES: To compare bipolar plasmakinetic (PK) with standard monopolar transurethral resection of the prostate (TURP). METHODS: A total of 70 patients were prospectively randomized into two groups: 35 patients underwent PK TURP with the Gyrus device, and 35 patients underwent standard monopolar TURP. We evaluated the time to catheter removal and hospital discharge, operating time, blood loss, postoperative irrigation, complications, urinary flow rates, symptom relief, and postvoid residual volumes. RESULTS: At baseline, the study groups were comparable in age, prostate volume, mean prostate-specific antigen value, International Prostate Symptom Score, quality-of-life score, flow rate, and postvoid residual volume. The mean catheterization time was 72 and 100 hours in the PK and standard groups, respectively. This difference was statistically significant (P <0.05), as was the difference in the time to hospital discharge. No difference was found in the mean resection time, amount of resected tissue, or variations in hemoglobin and sodium levels. The improvement in flow rate, postvoid residual volume, International Prostate Symptom Score, and quality-of-life score was comparable between the two groups at 12 months of follow-up. CONCLUSIONS: In our experience, PK TURP showed comparable perioperative results to those obtained with standard TURP, but with more favorable postoperative outcomes. The resection time and blood loss were similar between the two groups, but the need for continuous bladder irrigation after surgery and time to catheter removal and hospital discharge were significantly shorter in the PK group.