[Radial fascio-cutaneous flap of the forearm and myocutaneous gracilis muscle flap in urologic surgery: surgical anatomy and techniques]. / Il lembo fascio-cutaneo radiale dell'avambraccio e il lembo miocutaneo di muscolo gracile in chirurgia urologica: cenni di anatomia chirurgica e modalità di prelievo.

All the concepts and principles commonly espoused in plastic surgery are very useful in urologic reconstructive operations too. Hypospadia's repair, neo-bladder reconstruction, microsurgery of the seminal way require as certain rules as an absolute respect for anatomy, sparing of the finest tissue vascularization and tension free sutures. Pedicled skin flaps harvesting and utilisation are techniques typical of plastic surgery but are also largely used in urologic adult and paediatric surgery. They are adopted for urethral, penile and corpora cavernosa reconstruction. Pedicled flaps are utilised for the closure of large skin defect in case of complicated wound or when an urinary fistula is present, especially after radiotherapy. A perfect knowledge of the flap nourishment and of the method of harvesting is crucial if the best results must be obtained. In our work we describe the surgical technique for the utilisation of gracilis muscle and forearm flap. Special care is taken to the anatomical description.

Comparison of single preoperative oral rufloxacin versus perioperative ciprofloxacin as prophylactic agents in transurethral surgery.

The aim of this prospective clinical trial was to compare the efficacy of rufloxacin, a once-daily fluoroquinolone administered as a single pre-operative dose versus the perioperative prophylaxis with ciprofloxacin in transurethral surgery. Two hundred and two patients undergoing transurethral resection of bladder tumors (132) or transurethral resection of the prostate (70) were selected for the study between January 1997 and June 1998. Patients were randomized to two treatment groups. Group A received a single oral 200 mg dose of rufloxacin three hours before surgery and group B was administered oral ciprofloxacin 250 mg bid until catheter removal. The two treatment groups were homogeneous with respect to patient characteristics. One hundred and seventy-three patients (89 rufloxacin and 84 ciprofloxacin) were assessed and 29 were excluded from the statistical analysis. The incidence of postoperative infection was similar in both treatment groups (5.7% rufloxacin, 4.7% ciprofloxacin). On the other hand, single-dose pre-operative prophylaxis with rufloxacin significantly reduced the cost of antibiotic prophylaxis. Results of the present study show that single dose oral rufloxacin may be used in routine clinical practice as a preoperative prophylactic antibiotic due to its low cost, its documented efficacy and its simple once daily dosage regimen.

[Transrectal ultrasound-guided biopsy of the prostate]. / Biopsia prostatica ecoguidata con accesso transrettale.

The early detection of prostatic neoplasm is nowadays a primary need in the urological field. The availability of transrectal ultrasound equipment alongside with bioptic tools made possible that transrectal ultrasound-guided biopsy of the prostate became the standard procedure to achieve this goal. With this work we would like to confirm the efficacy of this method which is also associated with a good tolerance and low complications rate. 82 patients that came to our Department between 1997 and 1999 were submitted to this procedure, 25 resulted positive for prostatic adenocarcinoma. Only 2 of them did not tolerate the procedure while all the others referred only mild discomfort at the moment of the puncture; 9 patients afterwards had to be admitted to the hospital due to fever (1 patient), acute retention of urine (3 patients) and persistent macroscopic hematuria (5 patients). Transrectal ultrasound-guided biopsy of the prostate reveals to be a safe and accurate method to obtain tissue samples of the prostate along with high tolerance and low incidence of serious complications.

Long-term results with Nesbit's procedure as treatment of Peyronie's disease.

The objective was to assess sexual function at long-term follow-up after the Nesbit operation for Peyronie's disease. One hundred and fifty seven out of 213 patients treated between 1986 and 1998 using the Nesbit procedure were reassessed by means of IIEF-5 questionnaire together with two questions about residual deformity and treatment satisfaction. The results from this questionnaire together with the patient case records constitute the basis of this paper. After an average 72-month follow-up subjective patient determination of satisfaction indicated that 87.9% were satisfied with the results of surgery, 136 patients (86.7%) had good erectile function (IIEF-5 > 21). Shortening of the penis (from 1.5 to 3 cm) occurred in 22 patients (14%), but only in 2 (1.3%) was intercourse difficult because of excessive shortening. In conclusion, the Nesbit's operation results in the greatest amount of patient satisfaction about sexual function. When penile shortening occurs, it has not been a significant problem for patients who are properly counselled.

Saphenous vein harvesting by 'stripping' technique and 'W'-shaped patch covering after plaque incision in treatment of Peyronie's disease.

Harvesting of the saphenous vein tract by means of leg stripping is proposed in the treatment of Peyronie's disease. The technique of W-shaped saphenous vein after plaque incision to correct severe penile deformity associated with Peyronie's disease is described. Graft material was obtained from the lower saphenous vein by means of distal 'leg short stripping' technique. The size and number of tunical incisions depended on the size of the plaque. A 15 cm venous segment is generally sufficient to cover the defect. The venous segment used was W-shaped, assembled with 6/0 polydioxanone (PDS) uninterrupted sutures and then sutured to the albuginea defect. In our preliminary series of eight patients, penile shortening and erectile dysfunction is absent. Complete correction of penile deformity was achieved in seven patients (87.5%). One patient had minimal residual curvature (<20 degrees ) which did not result in difficulty with intromission. Saphenous harvesting by the stripping technique is not an invasive procedure and is quick and simple to perform. The W-shaped assembling technique is safe because the piece of saphena is kept intact and may be suited properly to the albuginea defect.

[Termino-terminal urethroplasty using microsurgical technique in the treatment of bulbar urethral stenosis: evaluation of long-term results and preservation of potency]. / L'uretroplastica termino-terminale con tecnica microchirurgica nel trattamento delle stenosi dell'uretra bulbare: valutazione dei risultati a lungo termine e conservazione della potenza sessuale.

The Authors report their experience, at long term, on the use of overlap anastomosis sec. Turner Warwick's technique for the treatment of posterior urethral strictures. 12 patients, from 17 to 58 years, were observed. Minimum follow-up was 43.3 months. All patients performed, pre and post-operatively, a retrograde cystogram, an uroflowmetry, a questionnaire to evaluate sexual potency by IIEF and AUA score, and some cases underwent also a cystoscopy post-operatively. Results demonstrated the effectiveness of technique five years later too, which is the period with the greater incidence of recurrences.

AMS 800 artificial sphincter: an unusual case of circumscribed peritonitis due to prosthetic reservoir infection.

OBJECTIVES: Male urinary incontinence is nowadays a rare event in patients submitted to radical prostatectomy. In these cases, insertion on a hydraulic prosthesis is often the only therapeutical solution. Complications following this type of surgery are rare and when they occur, generally depend on the bacterial contamination of the device which will be "rejected". The cuff is generally the first cause of infection and its prompt removal should solve the problem in the majority of the cases. METHODS: Herein we report the case of a patient submitted to cuff removal three years earlier who consulted for a symptomless circumscribed peritonitis due to bacterial contamination of the intraperitoneal reservoir. RESULTS AND CONCLUSION: This report emphasizes the need to re-examine the indications for intraperitoneal implantation of the reservoir. Moreover, in case of a three-component prosthetic device, the external components (pump, cylinders and/or cuff) should be removed in a single step, at the same time, in order to avoid future contamination of the internal components.

Antibiotic prophylaxis in prosthetic penile surgery: critical assessment of results in 75 consecutive patients.

OBJECTIVE: Antibiotic prophylaxis in prosthetic surgery was administered prospectively according an original protocol. Routine pre-operative preparation included also scrupulous, repeated disinfection of the skin of the genital and perineal region. METHODS: Vancomycin 500 mg i.v. every 6 h on the day of surgery and gentamicin 1 mg/kg i.v. every 8 h on the day of surgery and for the following 48 h were administered to 75 consecutive patients. Overall 87 prosthetic devices were implanted. The patients were evaluated at 6 weeks and at 6 months after surgery. RESULTS: No infection was observed. CONCLUSION: Support from this study to antibiotic prophylaxis in penile prosthetic surgery is uncertain. The importance of scrupulous routine pre-operative preparation is probably underestimated.

[Transvaginal echocystourethrography]. / L'ecocistouretrografia transvaginale.

The anatomo-physiologic appearances of female urination obtained with a new ultrasonographic technique is illustrated. The technique is performed using an intravisceral linear probe positioned in the vagina and a special chair which allows the urination in physiological position; at the same time the urination is videorecorded. The results, compared with X-Ray cystourethrography, enabled us to show the normal aspects (both dynamic and morphologic) and several pathologic aspects. Basing upon the direction of the urethra, it is possible to establish the change of the position of the floor and the neck bladder, which are often responsible of stress incontinence. The Authors stress the relative simplicity and noninvasiveness of the echographic technique. X-Ray radiation aren't used: this test is particularly advisable to study the urination disease of women in fertile-age.

[Critical considerations on the implant of penile prosthesis: indications, choice of prosthesis, surgical technique, and follow-up]. / Considerazioni critiche sull'impianto di protesi peniene: indicazione, scelta della protesi, tecnica chirurgica e follow-up.

The surgical techniques for penile prothesis implantation are well known and standardized. Multicomponent hydraulic prostheses offer, without any doubt, the best guarantees in terms of function and aesthetic results. Nevertheless their insertion is sometime troublesome and a superficial knowledge of the technical problems may lead to complete and disappointing failures. In the present work the Authors report their personal experience with various types of penile prostheses and describe in details, the different maneuvers which are needed for their correct implantation. Some variation of the original technique will be also described. The results obtained will also be described.

[Anatomo-functional study of penile innervation in the rat]. / Studio anatomo-funzionale dell'innervazione peniena nel ratto.

The Wistar rat represents a very useful model in experimental surgery and in scientific research. The anatomic structures are very similar to those encountered in man. Moreover the cost for their purchase, breeding and nourishment is very low and it's possible to perform surgical maneuvers without sterility. Nevertheless the penis has an extremely small dimension and its anatomic structure is quite different from that of man because corpora cavernosa are almost completely occupied by an osteo-cartilagenous formation: the os penis. For this reason it's very difficult to perform a physiopathological study of erection on the rat. On the other hand the nervous fibres are very similar for course and localization to those encountered in man and monkeys. Their electrical stimulation causes an erection which is adequate in duration and intensity to be evident.

[Critical assessment of penile prosthesis implants: indication, choice of prosthesis, surgical technique and follow-up]. / Considerazioni critiche sull'impianto di protesi peniene: indicazione, scelta della protesi, tecnica chirurgica e follow-up.

The surgical techniques for penile prosthesis implantation are well known and standardized. Multicomponent hydraulic prosthesis offer, without any doubt, the best guarantees in terms of function and aesthetic results. Nevertheless their insertion is sometime troublesome and a superficial knowledge of the technical problems may lead to complete and disappointing failures. In the present work the Authors report their personal experience with various types of penile prosthesis and describe in details, the different maneuvers which are needed for their correct implantation. Some variation of the original technique will be also described. The results obtained will also be described.