[Legal medical considerations on a case of erectile dysfunction]. / Considerazioni medicolegali su un caso di disfunzione erettile.

The primary obstruction of the bladder neck is a condition which is diagnosed in many young people with symptoms of lower urinary tract, such as obstructive symptoms (difficulty in the initial phase of urination and urinary retention) and irritative symptoms (pollakiuria, dysuria and nocturia). These tests are needed for the diagnosis: uroflowmetry, urodynamics, rx urethrocystography. For the treatment are used alpha-blockers or surgery. The main diagnostic test is the urodynamic study. Even though the alpha-blockers are effective and safe drugs, sometimes the treatment is surgical. The gold standard is the transurethral incision of the prostate or bladder neck (TUIP), a technique with good results, but with some complications, including retrograde ejaculation, that is the most dangerous, and erectile dysfunction, that occurs in a lower percentage of patients. In this work was studied, in terms of forensic medicine, the case of a patient who is 35 years old and reported erectile dysfunction after an intervention of transurethral incision of the prostate or bladder neck. Although there is a limited possibility, documented in the literature, of erectile dysfunction as a result of TUIP, there is no sufficient evidence to confer the responsibility of patient's organic nature impotence to the health professional civil conduct which is directly related to the transurethral incision of the bladder neck, considering the presence of a lumbo-sacral disc disease in the patient, documented by CT two years before the surgery.

[Medico legal considerations on prosthesis surgery of the erectile dysfunction in a La Peyronie disease case]. / Considerazioni medico legali sulla chirurgia protesica della disfunzione erettile in un caso di malattia di La Peyronie.

Peyronie's disease is characterized by the presence of an inelastic fibrous plaque of the penile tunica albuginea affecting 3-10% of the male population. The fibrous scar causes the curvature of the erect penis, which prevents the penetration. In the stabilization phase the plaque can cause a variable degree of erectile dysfunction (20-54%). In the treatment of the chronic disease, surgery is the gold standard and in case of concomitant erectile dysfunction the placement of a penile prosthesis is indicated. This surgery is loaded with an increase of the variables which can affect the outcome, such as individual clinical features and functionality of the device. The present case concerns a patient suffering from erectile dysfunction associated with Peyronie's disease who underwent surgery for implantation of hydraulic three-component penile prosthesis. After surgery a malfunction of the prosthesis was detected, which required unloading measures under sedation and a surgical revision of the scrotal pump. The latter was followed by the displacement of the prosthesis' cylinder and by a new surgical treatment for the reintegration of the prosthesis and the repair of the left corpus cavernosum. After two months a wrong positioning of the two cylinders inserted into the corpora cavernosa, with the left cranial extreme positioned 2 cm below the contralateral, was detected. In this case the failure of surgical treatment highlights a negligent behavior and the responsibility of the doctors by failing to examine adequately the variables, both clinical and not clinical, that might affect the outcome of the intervention.

Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals.

Many techniques have been described to create an aesthetic and functional neo-phallus after penile amputation or in female-to-male transsexuals. Microsurgical free-flap phalloplasty seems to be the preferred method of penile reconstruction. For many years the radial forearm free flap has been considered the best procedure, but other flaps have been attempted to minimize donor site morbidity and optimize outcome. Pedicled flaps are considered to be reliable and to decrease the risk of total failure. Recently, a one-stage non-microsurgical technique was described for phallic reconstruction in a young male patient. We report successful total phallic reconstruction in a female-to-male transsexual patient using an island pedicled anterolateral thigh (ALT) flap. Urethral reconstruction was left as a possible further procedure due to patient's preference. A malleable soft silicone penile prosthesis was inserted within the flap and the lateral cutaneous femoral nerve stump was sutured to the dorsal clitoris branch from the pudendal nerve for flap sensation. After 6 months, the patient demonstrated successful aesthetic and functional reconstruction referring to satisfactory sexual activity. To our knowledge, this is the first report of an innervated island pedicled ALT flap used for female-to-male penile reconstruction in a transsexual patient. The pedicled ALT flap may be a reliable option to avoid visible scarring at the donor site on exposed parts of the body, and reduce the risk of total flap failure from microsurgical procedures for reconstruction of a neo-phallus in this increasing population of patients.

[Contraception and voluntary sterilization: male sterilization and the possibility of reversal]. / Stato attuale della sterilizzazione volontaria nellambito della contraccezione: la sterilizzazione maschile e sua reversibilita.

PIP: Vasectomy is a simple and safe procedure, regularly done on an outpatient basis. Since spontaneous recanalization of the vasa deferentia is always possible, researchers have experimented with other means of surgical obstruction of the vasa; such experiments, which involved silastic plugs, intravasal threads, tantalium clips, and hard or soft valves, have not been very successful. Together with an increased demand for vasectomy goes an increased demand for vasectomy reversal. Vas reanastomosis is an extremely difficult and lengthy surgical procedure; failure is usually due to anatomical and/or functional causes related and consequent to the previous vasectomy. If reversibility is surgically successful in 60% of cases, the functional success of the procedure is only about 40%. Hence the importance of sound judgment, maturity and objective counseling prior to sterilization.^ieng

Histological lesions in the testis of infertile men with varicocele.

Varicocele frequently causes male infertility and histological lesions at the contralateral testis. The most frequent lesions found in this study included maturation arrest in the spermatidic phase, cellular and acellular thickening of the tubular wall, and degeneration of the Leydig cells. These lesions were typical of varicocele and their simultaneous presence suggests that scrotal temperature and modified endocrine secretion of the interstitial testis play a role in the pathogenesis of this type of infertility.