Iatrogenic ejaculation disorders and their prevention.

Ejaculation is mediated by sympathetic fibers originating from the D10-L2 medullar center. These nerves rise from the lumbar ganglia of the paravertebral sympathetic trunk and travel posteriorly to the vena cava and then to the interaortocaval space, on the right side, and laterally to the aorta, on the left side. They are the principal constituents of the superior hypogastric plexus. Many surgical operations can cause an ejaculation disorder, but the most important is retroperitoneal lymphadenectomy (RL) for testis cancer, because it involves young patients and it has been the subject of important researches in order to perform lymph node dissection without ejaculation loss (unilateral lymphadenectomy and nerve sparing lymphadenectomy). Our experience concerns 41 patients who underwent RL for testis cancer from 1983 to 1998. Survival rate was 95.2% (mean follow up 64 months). RL was performed bilaterally in 14 patients. Two of them died of metastases within 2 years after the operation. Ejaculation was maintained in only 4 of the 12 surviving patients (33%). All the 17 patients (100%) underwent right monolateral RL and 7 of the 10 (70%) underwent left monolateral RL preserved ejaculation. The anatomosurgical concepts of the RL sparing the ejaculation can be adopted in other retroperitoneal surgical operations that can produce ejaculation disorders, such as wide lymphadenectomy for renal cell carcinoma or tumors of the upper urinary tract, exeresis of pre- aortic tumors, exeresis or disjunction of horseshoe kidney and aorto-iliac revascularization. Surgical therapy of benign prostatic hyperplasia (BPH) (open surgery or transurethral prostatic resection) is associated with retrograde ejaculation in nearly 100% of cases. The mechanism of the dysfunction is clear, if following the procedure the bladder neck remains opened. Loss of ejaculation is reported in variable percentage after the newer endoscopic techniques for the treatment of BPH. Transurethral needle ablation (TUNA) seems to have the lower risk of retrograde ejaculation. Retrograde ejaculation can also be related to a traumatic injury of the posterior urethra, because of the trauma itself or the therapy. Finally, the ejaculation disorder can be produced by several drugs that block, as a main or secondary effect, the alpha-adrenoreceptors or act at the central level. This side effect has to be kept in mind when these drugs are used in young or sexually active patients.

Aldosterone inhibition limits collagen synthesis and progressive left ventricular enlargement after anterior myocardial infarction.

BACKGROUND: The reparative process after myocardial infarction is related to active collagen synthesis. Previous experimental studies demonstrated that cardiac fibrosis is mediated by angiotensin II and aldosterone; this mechanism is not clearly confirmed in patients who have had a myocardial infarction. The aim of this study was to evaluate whether the suppression of aldosterone may be helpful in reducing postinfarction collagen synthesis (and progressive left ventricular dilation) in patients treated with an angiotensin-converting enzyme inhibitor for a recent myocardial infarction. METHODS: We enrolled 46 patients (ages 60+/-11 years, 34 males) with a first episode of anterior transmural thrombolized myocardial infarction. At hospital discharge patients were randomized to receive potassium canrenoate, an oral aldosterone inhibitor, 50 mg once daily (group 1, n = 24) or placebo (group 2, n = 22). All enrolled patients were on angiotensin-converting enzyme inhibitor therapy. The serum concentration of the aminoterminal propeptide of type III procollagen was used to measure the collagen synthesis rate; dosage was obtained before enrollment, at hospital discharge, and after 3, 6, and 12 months of follow-up. RESULTS: After 3, 6, and 12 months of treatment, the aminoterminal propeptide of type III procollagen serum levels was significantly higher in the placebo group compared with the aldosterone inhibitor group; after 6 and 12 months we observed significantly smaller left ventricular volumes in the active treatment group. CONCLUSION: Potassium canrenoate, combined with an angiotensin-converting enzyme inhibitor, may reduce postinfarction collagen synthesis and progressive left ventricular dilation.

Effects of transdermal 17beta-estradiol on left ventricular anatomy and performance in hypertensive women.

To reduce cardiovascular complications, antihypertensive therapy should not only normalize blood pressure but also induce a regression of structural abnormalities, which are the expression of end-organ damage. We investigated the effects of transdermal 17beta-estradiol, combined with standard antihypertensive therapy, on the modification of left ventricular anatomy and systolic performance in hypertensive postmenopausal women. In a randomized, double-blind, placebo-controlled study, we enrolled 169 postmenopausal women with mild or moderate hypertension. Eighty-six patients (group 1) received transdermal 17beta-estradiol (50 microg/d) and norethisterone acetate (2.5 mg/d, orally), and 83 patients (group 2) received placebo. At baseline, all women underwent M-mode and 2-D echocardiogram, which was repeated after 6, 12, and 18 months of follow-up. After 18 months of treatment, we observed a significant decrease in left ventricular diastolic septal and posterior wall thickness and mass in both groups. Furthermore, after 18 months, left ventricular mass was significantly less than in the estrogen-treated group. No significant modifications were observed in left ventricular systolic and diastolic dimensions or in systolic performance, as expressed by left ventricular fractional shortening. In conclusion, transdermal 17beta-estradiol, which is associated with antihypertensive therapy, may contribute in the reduction of left ventricular mass in hypertensive postmenopausal women.

Chemotherapy with FUDR in the management of metastatic renal cell carcinoma.

SUMMARY: Metastatic renal cell carcinoma has a poor prognosis, requiring systemic therapy, in addition to radical nephrectomy. Since August 1989, 50 patients were treated with continuous, systemic, chronobiological infusion of FUDR (floxuridine) at our Institution. We reported 11.7% of objective responses, a long period of stable disease and low toxicity. We also compared our actuarial survival with the results obtained with recombinant IL-2 treatment.

[Perineal functional rehabilitation in female urinary stress incontinence]. / La rieducazione funzionale perineale nella incontinenza urinaria femminile da stress.

Since January 1985 13 female patients with urinary incontinence induced by pure stress have been subjected to perineal functional rehabilitation at the S. Giovanni Battista Hospital Functional Rehabilitation Service and Turin Health Service Unit 23 in collaboration with the hospital's Urology Division. The results are encouraging and suggest that this treatment may be a valid alternative to surgery.