Morphological changes on the intestinal mucosa in orthotopic neobladder.

INTRODUCTION: The intestinal mucosa undergoes significant atrophic changes when it is used to reconstruct the urinary tract. We analyzed the ultrastructural changes of intestinal mucosa in the orthotopic neobladder on the basis of our clinical experience. PATIENTS AND METHODS: Fifteen male patients with an ileal neobladder underwent endoscopic biopsy at different postoperative intervals. RESULTS: No significant changes were observed 3 months after surgery. After 6 and 12 months, the structure of the microvilli was modified significantly. No other substantial changes after 24 months were observed. CONCLUSIONS: Progressive modifications occur in the cytoplasmic structures involved in the absorptive process. They do not seem to begin before 3 months and are almost totally completed after 1 year.

[Sexual dysfunctions in female with neurological disorders]. / Disfunzioni sessuali nella donna con patologia neurologica.

Female sexuality is a controversial issue due to its embarrassment and to paucity of literature publications. The neuroanatomy and neuromediators involved in female sexuality are important but not so fundamental as in men. There are three sexual female dysfunctions (SFD): primary, secondary, tertiary. In the primary one, the sexual dysfunction (SD) is correlated to the neurological disease, in the secondary the SD derives from the symptoms of the neurological disease, in the tertiary the SD is the psychological reaction to the effects of the disease. We analyse the FSD in neurological diseases, as the outcome of medulla trauma, multiple sclerosis, epilepsy, Alzheimer, Parkinson, diabetes, outcome of pelvic surgery. Female sexuality (FS) is difficult and complex compared to male sexuality. Women with medulla lesion feel some discomfort when having to go and speak to their doctor: they are afraid of pregnancy, sexual intercourses, bladder and rectal functions. In women with newly diagnosed multiple sclerosis, there is a tertiary sexual dysfunction. Medical therapy worsens female sexuality as in case of epilepsy. Emotional and behavioural disorders involve sexual dysfunctions in women with Alzheimer. In Parkinson, reduction of sexual desire involves break of sexual intercourses. SD are more frequent in complicated diabetes. In pelvic surgery, pelvic autonomic dysfunction and depression correlated to the oncology disease, contribute to the FSD. Sexual counselling, especially in young women with medulla lesion or multiple sclerosis, is the best therapy, and learning erotic extragenital areas able to make sensations similar to the orgasms.

Filariasis: an emergent cause of acute scrotal pain.

A 25-year-old man from Bangla Desh with acute right scrotal pain was subjected to scrotal surgical exploration because of the suspicion of testicular torsion. The testicle appeared normally positioned; an epididymal nodule was removed, and pathology showed the presence of the filaria worm. Filariasis is a tropical disease which has been estimated to affect 120 millions people throughout the world. Lymphadenitis and lymphangitis are the more common clinical settings; in men, there is a frequent scrotal involvement. In some cases, acute scrotal pain may lead to the suspicion of testicular torsion. The observation of patients with genital filariasis is likely to become more frequent in an era of massive immigration from different countries; nowadays, the disease should always be taken into consideration in the differential diagnosis in patients with acute scrotal pain coming from tropical areas.

Evaluation of the female sexual function after vaginal surgery using the FSFI (Female Sexual Function Index).

Urinary Incontinence (UI) and Pelvic Organ Prolapse (POP) have a detrimental effect on Female Sexual Function (FSF). We decided to focus on the effect of vaginal surgery for UI and/or POP on FSF. MATERIALS AND METHODS. 72 women (aged 42-80, mean age: 62) were given the FSFI questionnaire after undergoing the following operations: 54 Tension-Free Vaginal Slings (TFVS), 12 Kelly plications, 3 hysterectomies+Kelly, 2 Tension-Free Vaginal Slings+Kelly, 1 hysterectomy+ Kelly+posterior IVS. RESULTS. 35 women did not answer the questionnaire, 6 women were sexually inactive and answered only partially; 31 patients answered completely. Mean pre- and postoperative scores were, respectively, 25.26 and 25.22 (normal >26.55). 9 patients had a normal preoperative score, whereas 22 a pathological score. The FSFI score did not change postoperatively in 26 women; it worsened in 3 and improved in 2 women treated because of coital incontinence. CONCLUSIONS. Vaginal surgery for UI and/or POP does not seem to affect FSF in the great majority of cases; conditions may worsen or improve, the latter definitely resulting from the treatment of Coital Incontinence. The high number of patients not answering the questionnaire deserves further studies and it could be - at least partially - explained on the basis of psychological and/or cultural problems regarding the highly emotional issues of sex, incontinence and prolapse.

Free DNA in urine: a new marker for bladder cancer? Preliminary data.

The aim of the present preliminary study was to investigate the presence of free DNA (FDNA) in urine as a possible marker for the diagnosis of bladder cancer. Naturally voided morning urine specimens were collected from 57 patients with suspected bladder cancer before cystoscopy. A standard urine test was performed; the specimens were then processed in order to obtain a quantitative evaluation of the presence of free DNA in the urine. Twenty-two patients were excluded from the study because they had leukocyturia and/or bacteriuria. Free DNA concentrations higher than 250 ng/mL were found in all 16 patients showing bladder cancer at cystoscopy and in seven (36.8%) of the 19 patients with negative cystoscopy. Urinary FDNA seems to have an excellent sensitivity: we observed no false negative cases and 36.8% false positive cases. By contrast, only 6.25% of the bladder cancer patients had positive urine cytology. Our results seem promising, although further studies and larger numbers are needed to define urinary free DNA as a reliable marker of bladder cancer.

Colonic metaplasia in the long-term follow-up of the ileal neobladder.

OBJECTIVE: To look for the presence of colonic metaplasia (CM), the shifting from sialomucins (SIs) to sulfomucins (SUs), considered as a probably premalignant lesion in the stomach in the mucosa of the ileal neobladder (IN). METHODS: 19 patients with IN were subjected to endoscopic biopsy; the samples were analyzed by means of histochemistry with high iron diamine, a test indicated to identify SIs and SUs. RESULTS: CM was never observed earlier than 1 year after the operation, was absent in 9/19 patients (mean follow-up 14 months) and present in 10/19 (mean follow-up 59 months). CONCLUSION: Time-dependent phenotypic changes, already described in the stomach as being premalignant, take place after constant contact with urine in the mucosa of the IN. It is at present unclear whether they may be defíned as only metaplastic or frankly preneoplastic; anyway, a careful follow-up remains indicated in all patients with íntestinal urinary diversions.

[Phenotypic changes in mucin-secreting cells in the ileal neobladder mucosa: a metaplastic or precancerous lesion?]. / Modificazioni fenotipiche delle cellule mucino-secernenti nella mucosa delle neovesciche ileali: lesione metaplastica o precancerosa?

Colonic metaplasia with shifting from sialo-to sulfomucins was observed in 10/18 patients with ileal orthotopic neobladder; their median follow-up was 59 months. There is a significant statistical relationship (p = 0.002) between Colonic Metaplasia and a follow-up longer than 14 months. Diversion Cancer is nowadays a practical problem and probably urologists will be confronted with it in the future more than at present. A modification of established attitudes as regards urinary diversion in standard situations (i.e., 60 over years old patients with invasive bladder cancer) don't seems, at present, justified, although our study confirms the suspicion that ileal neobladder could be considered theoretically at risk for cancer onset.

Ultrastructural mucosal appearance in the ileal neobladder.

METHODS: 15 patients with ileal neobladder underwent endoscopic biopsy at different postoperative intervals. The specimens were analyzed by electron microscopy in order to evaluate the evolution of the mucosal changes ultrastructurally. RESULTS: No significant change was observed 3 months after the operation. After 6 months, the number and height of the microvilli were reduced, the cell borders crooked and the terminal web upset. After 12 months disappearance of the glycocalyx, increased lysosomal features, increased activity of the muciparous cells, rounded mitochondria and loss of the polarized disposition of the cytoplasmic organelles were detected in the enterocytes. We observed no other substantial change after 24 months and more. CONCLUSIONS: Progressive modifications occur in the cytoplasmic structures involved in the absorptive process. They do not seem to begin before 3 months and are almost totally completed after 1 year.

[Imposing "calcium milk" lithiasis in giant hydronephrosis]. / Imponente calcolosi a "latte di calce" in idronefrosi gigante.

The authors report a quite unusual case of "milk of calcium renal Stone" in unilateral giant Hydronephrosis. Radiographic, sonographic, intravenous urographic and TC aspects are described and prominence il given to morphostructural information obtained through digital image techniques of pyeloureteral zone junction and of "milk of calcium renal Stone". The authors discuss the pathogenesis of the renal Stone type and emphasize the convenience of investigative acts to clear up the ethio-pathogenetic role of pyeloureteral infections.

Self-introduction of foreign bodies into the urethra: a multidisciplinary problem.

A 36-year-old man was hospitalized for self-insertion of a metallic body into the urethra. The self-inserted foreign body (SFB) was removed by endoscopic means; psychiatric evaluation of the patient showed a disturbed schizoid personality. After a review of the current literature, including clinical features, diagnostic manoeuvres and methods of treatment of SFB, the authors suggest that a psychiatric evaluation is always recommended in order to discover mental underlying disorders, thus reducing the risk of recurrence.

Focal xanthogranulomatous pyelonephritis: diagnostic and therapeutic aspects.

The authors report 2 cases of localized xanthogranulomatous pyelonephritis (XGP) in which computed tomography (CT) permitted to raise a motivated clinical suspicion of inflammatory disease: the surgical exploration documented absence of neoplasm and allowed a conservative therapy implying only the removal of the mass. A literature review confirms that some CT signs in XGP permit differentiation from carcinoma. If they are present, in unifocal cases of disease, the authors suggest a limited surgical approach and a therapeutic strategy as conservative as possible.

Vesical instillation of emepronium bromide in defunctionalized postobstructive noncompliant bladder: an alternative to intestinal augmentation surgery?

A contracted noncompliant bladder is an infrequent but severe complication of cutaneous ureterostomy. Recently, we effected a significant increase in bladder capacity by long-term, gentle hydraulic dilation with saline solution plus an anticholinergic drug (emepronium bromide). Based on this experience, we suggest a conservative approach like this before electing a patient for bladder augmentation or permanent diversion for any child with vesical contracture.

Congenital polyp of the prostatic urethra: report on 2 cases.

Congenital polyps of the prostatic urethra are an uncommon cause of obstructive uropathy, infection and/or hematuria in male children. A filling defect localized in the posterior urethra on the voiding cystourethrogram represents the peculiar diagnostic finding. Transurethral resection is the treatment of choice, according to the size of the polyp. Two cases of congenital posterior urethral polyps are reported and the main clinical and radiological features are discussed. This lesion has to be considered in the differential diagnosis of the voiding dysfunction in young boys.