[Anatomy of the urethral sphincteric vesico-prostatic complex]. / Anatomia del complesso sfinterico vescico-prostatico uretrale.

As 27 different names have been proposed for the components of the urethral sphincter, it is difficult to build a clear anatomical model of it. Starting from a review of the literature and from some personal observations of surgical anatomy, our aim is to draw a vision as much organic as possible of the anatomy of the urethral sphincter. The components of the urethral sphincter are: the bladder neck (preprostatic sphincter), the smooth muscle urethral sphincter, the rhabdosphincter and levator ani muscle. Recently the rhabdosphincter has been proposed as a vertical structure that extends from the pelvic cavity (bladder base) to the perineal cavity. It can be round-shaped or omega-shaped. The anterior insertions are along the anterolateral aspect of the prostate (superiorly) and on the perineal fascia (inferiorly). The posterior insertions are on the Denonvilliers fascia and posterior aspect of the prostatic apex (superiorly) and on the central perineal tendon (inferiorly). The rhabdosphincter has strong means of fixations: anteriorly it is fixed to the pubis by the pubo-urethral ligaments, posteriorly it is supported by the medial fibrous raphe of the perineum. The anteromedial fibres of levator ani muscle are involved in the continence mechanism by their strong relation with the rhabdosphincter and the prostate.

[Personal research: reconstruction of the urethral striated sphincter]. / Ricerca personale: la ricostruzione dello sfintere striato uretrale.

OBJECTIVE: Incontinence is one of the drawbacks of radical prostatectomy. The causes of post-operative incontinence are sphincter deficiency (SD) and bladder dysfunction (BD). SD seems to be the main cause of incontinence and long time to continence. We present a surgical modification of the anatomical radical retropubic prostatectomy consisting in the reconstruction of the posterior aspect of the striated urethral sphincter in order to obtain a quick recovery of continence postoperatively. MATERIALS AND METHODS: Caudal retraction of the urethro-sphincteric complex after apical dissection of the prostate often occurs. Furthermore posterior fibrous raphe interruption can cause shortening of anatomical and functional urethral length and affect continence. In order to avoid caudal retraction of the sphincteric complex, after completing vesico-urethral anastomosis, the posterior emicircumference of the striated sphincter is fixed to the posterior aspect of the bladder one centimeter cranially and posteriorly to the urethro-vesical anastomosis. The rabdosphincter is sutured separately from the urethro-vesical suturing. This technical modification makes it possible to obtain an anatomical length of the urethra of about a centimeter more than with the standard technique, replacing it in a more anatomical position. Furthermore, this technique provides the new posterior platform for the urethro-sphincteric complex. Twenty-four patients with clinical organ confined disease and age range 54-74 years (mean 64 years) underwent Walsh's anatomical radical retropubic prostatectomy with reconstruction of the rabdosphincter (group A). Catheter was removed 7 to 11 days postoperatively. Early continence was assessed objectively with the number of pads per day as follows: 0-1 mini pad = continent; 1-2 pads per day = mild incontinence; 2 or more pads per day = severe incontinence. Continence was evaluated at 3 days and one month after catheter removal. Group A compared to 21 patients (group B) who underwent standard anatomical RPP (historical control group). RESULTS: In group A 16/24 patients (66.7%) and 19/24 patients (79.2%) were continent respectively at three days after removal of the catheter and after one month; mild incontinence (1-2 pads/day) was present in 6/24 patients (25%) and 3/24 (12.5%) respectively, 2/24 patients (8.3%) suffered from severe incontinence after 3 days and one month. In group B 7/21 patients (33%) were continent at hospital discharge, 11/21 (52%) after one month. CONCLUSIONS: Careful reconstruction of the posterior aspects of the rabdosphincter shortens time to continence after RRP.

[Prostatic volume: suprapubic versus transrectal ultrasonography in the control of benign prostatic hyperplasia]. / Volumetria prostatica: confronto tra studio ecografico sovrapubico e transrettale nel controllo dell'iperplasia prostatica benigna.

INTRODUCTION: During the follow-up of benign prostatic hypertrophy, the urologist needs the repeated evaluation of the gland size to monitor the effectiveness of drug treatment. We investigated the comparative adequacy of transabdominal and transrectal US for prostatic measurements, to possibly replace the gold standard transrectal examination with cheaper, easier and less invasive transabdominal studies. MATERIAL AND METHODS: February, 1994, to May, 1996, we submitted 196 patients to prostate US, with a transabdominal convex probe and a transrectal biplanar probe. The three prostatic diameters were measured and prostatic volume and height calculated. RESULTS: The transverse diameter was the same (+/- 5%) in 31.6% of cases, but transabdominal US overestimated it in 41.8% and underestimated it in 26.5% of cases. The AP diameter was the same in 33.1% of cases, but trans-abdominal US overestimated it in 15.3% and underestimated it in 51.5% of cases. The cranio-caudal diameter was the same in 25.5% of cases, but transabdominal US overestimated it in 59.1% and underestimated it in 15.3% of cases. Consequently, the volume calculated with transabdominal US was the same (+/- 15%) in 27.5% of cases, overestimated in 45.9% and under-estimated in 26.5% of cases; prostatic weight rates were about the same. CONCLUSIONS: Prostatic volume and weight measured with transabdominal US are overestimated in about 50% of cases and are the same (+/- 15%) in about 27% of cases only. Therefore, transabdominal US appears less reliable than transrectal US for prostatic measurements and the latter technique remains the gold standard to monitor drug treatment effectiveness in benign prostatic hypertrophy follow-up.

Chromatin structure in bands and interbands of polytene chromosomes imaged by atomic force microscopy.

Polytene chromosomes from Drosophila melanogaster, observed from squash preparations, and chromosomes from Chironomus thummi thummi, investigated under physiological conditions, are imaged using an Atomic Force Microscope. Various chromatin fiber structures can be observed with high detail in fixed chromosomes and correspond to structures which are also observed in chromosomes of diploid cells. Unfixed chromosomes can be imaged in buffer and show less fiber-like details because of the inherent soft nature of the chromatin material.

[Treatment of prostate adenoma with finasteride. Contribution of cases]. / Trattamento dell'adenoma prostatico con finasteride. Contributo casistico.

During recent years more and more researchers and clinicians have become interested in HPB in order to identify a medical therapy instead of surgery. The aim of our study was to find the value of finasteride in HPB therapy. We wanted to know if finasteride was able to improve the symptomatology and blood tests of patients afflicted with HPB. Every patient was agreed with the course of action of the 1991 Paris Urology Congress. All patients were treated with finasteride 5 mg/die for one year and inspected by prostatic echography and blood tests. The results of our study are every interesting and are discussed in the article.

[Transrectal prostatic echography in the study of hemospermia. An assessment of an 85-patient case load]. / L'ecografia prostatica transrettale nello studio dell'emospermia. Valutazione di una casistica di 85 pazienti.

Eighty-five patients with hemospermia were examined with blood tests, sperm culture, transrectal US (TRUS) and cystourethroscopy. Blood tests and sperm culture demonstrated bacterial inflammation in 48 patients (56.47%). At cystourethroscopy, the urethra was normal or hyperemic in all patients. TRUS demonstrated 40 cases (47.05%) of periurethral calcifications and also with calcifications in the two glandular lobes. TRUS also demonstrated prostatic inflammation in progress or its outcome in 21 patients (24.70%), ectasia and seminal vesicle inflammation in 10 patients (11.76%), a prostatic tumor in 3 patients (3.52%). No patient had cysts, stones or cancers in the seminal vesicles. In 11 patients (12.94%), no specific cause of hemospermia was detected, even though 4 of these patients (4.70%) had received anticoagulants for former heart ischemia. Benign prostatic hypertrophy was found in 44 patients (51.76%) but we did not consider it a possible cause of hemospermia because of the high frequency of this condition in the male population. To conclude, TRUS could demonstrate the cause of hemospermia in most of our patients, which makes us suggest it as the diagnostic technique of choice in the patients with ejaculatory conditions, after clinical exams and laboratory tests, because it allows to study the prostate, the seminal vesicles and the urethra.

Reduction in urinary prostaglandin excretion in the premenstrual syndrome.

The purpose of the present work was to study some factors involved in renal handling of salt and water in the premenstrual syndrome (PMS), in which salt and water retention is frequently observed. In 18 women with PMS and in 18 healthy women we studied the levels of cyclic adenosine monophosphate, aldosterone, prostaglandin E2, prostaglandin F2 alpha and kallikrein in urinary samples collected during the luteal phase. There was no difference between the two groups regarding sodium, aldosterone and kallikrein urinary excretion. In the PMS group there was a significant reduction in urinary excretion of cyclic adenosine monophosphate, prostaglandin E2 and prostaglandin F2 alpha with respect to the control group. At multivariate analysis sodium urinary excretion proved not to be the same as the model validated in healthy women. There may be different renal handling of water and electrolytes during the luteal phase of the menstrual cycle in women with PMS.

Non invasive detection of venogenic impotence: real-time US evaluation of periprostatic (Santorini's) venous plexus after (PGE1) induced erection.

The diagnosis of venous impotence is actually reached through cavernometry and cavernography. These procedures are somewhat painful, invasive, time consuming and not always free from side effects. Anatomo-physiological studies have assessed connections between periprostatic (Santorini's) plexus and deep venous drainage of the penis. Moreover, dilated periprostatic plexus is a common ultrasound finding in the phlogistic pathology of the prostate and it is often the cause of temporary functional impotence. 20 Patients suffering from venous impotence, previously assessed by flow/pressure studies, underwent real time transrectal scan (Kretz Combison 330 equipped with 7.5 MHertz multiplanar probe) before and after Prostaglandins E1 (PGE1) (Prostin VR-Upjohn) induced erection recorded by computerised rigidometer (RigiScan-Dacomed). Dilated periprostatic venous plexus associated with tumescence or unstable valid erection ("tooth-saw-trace") was considered diagnostic for venogenic impotence. Real time ultrasound evaluation after PGE1 induced erection is to be considered a reliable method in the qualitative assessment of venogenic impotence. The procedure allows, moreover, a more accurate urologic assessment and is also useful in the early detection of various prostatic disease which are, like erection disorders, often age-related. Customary diagnostic procedures (cavernometry and caverography) may represent a second-line or pre-surgical assessment policy.

Digital subtraction angiography of the kidney.

Intravenous and intra-arterial digital subtraction angiography (DSA) was performed in 88 patients: 34 with tumours, 10 with renal trauma, 26 with suspected renovascular hypertension, 6 with vascular impression on the renal pelvis, 8 with nephrolithiasis and 4 with sonographically abnormal kidneys. Venous and arterial DSA always gave diagnostically useful images. Intravenous DSA is valuable in patients with suspected renovascular hypertension or after vascular surgery, percutaneous transluminal angioplasty and transcatheter embolisation. Arterial DSA is preferable to venous DSA in other clinical situations, particularly in the evaluation of renal tumours, and may be recommended in preference to conventional angiography.