Endoscopic holmium laser management of tension-free vaginal tape eroded into the bladder.

INTRODUCTION: Tension-free vaginal tape (TVT) procedure is not free from intra- and postoperative complications. Diagnosis of mesh erosion is often underestimated by clinicians due to its unspecific symptoms. Urinary symptoms not responding to medical therapy should be investigated by cystoscopy to exclude mesh erosion. We report our experience with holmium laser for the endoscopic management of mesh erosion in three patients. PATIENTS AND METHODS: We describe three cases of mesh erosion after TVT placement treated with laser excision of the eroded tape into the bladder. In one case, a 4 × 3 cm stone adhering to the mesh was present. The procedures were performed under spinal anesthesia. The polypropylene eroded mesh was mobilized with forceps to better expose the intramural portion of the sling, and it was disintegrated with holmium laser as close to the bladder mucosa as possible. RESULTS: No complications were recorded. The patients were discharged after 24 h. In only one case, we had recurrent mesh exposure requiring a second procedure. After a mean follow-up of 15.3 months (range 12-20), the patients are asymptomatic with no evidence of tape erosion. CONCLUSIONS: Intravesical mesh erosion can complicate sling procedure. Endoscopic holmium laser management is a useful treatment for mesh removal and stone lithotripsy. Repeated treatments are possible for the low morbidity and minimal invasiveness. A regular follow-up is necessary.

The Female Sexual Function Index (FSFI): linguistic validation of the Italian version.

INTRODUCTION: Although several new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening and one of the most widely used questionnaires. The Italian translation of the FSFI has been used in several studies conducted in Italy, but a linguistic validation of the Italian version does not exist. AIM: The aim of this study was to perform a linguistic validation of the Italian version of the FSFI. METHODS: A multicenter cross-sectional study conducted in 14 urological and gynecological clinics, uniformly distributed over Italian territory. We performed all steps necessary to determine the reliability and the test-retest reliability of the Italian version of the FSFI. The study population was a convenience sample of 409 Italian women. MAIN OUTCOME MEASURES: The reliability of the questionnaire was calculated using Cronbach's alpha, which was considered weak, moderate, or high if its value was found less than 0.6, between 0.6 and 0.8, or equal to or greater than 0.8, respectively. The test-retest reliability was assessed for all women in the sample by calculating Pearson's concordance correlation coefficient for each domain and for the total score, both at baseline and after 15 days (r range between -1.00 to +1.00, where +1.00 indicates the strongest positive association). RESULTS: Cronbach's alpha coefficients for total and domain score were sufficiently high, ranging from 0.92 to 0.97 for the total sample. The test-retest procedure revealed that the concordance correlation coefficient was very high both for FSFI-I total score (Pearson's P = 0.93) and for each domain (Pearson's P always >0.92). CONCLUSION: For the first time in the literature, our study has produced a validated and reliable Italian version of the FSFI questionnaire. Consequently, the Italian FSFI can be used as a reliable tool for preliminary screening for female sexual dysfunction for Italian women.

Primary bilateral seminal vesicle carcinoma: description of a case and literature review.

With no more than 60 reported cases, tumors of the seminal vesicles are rare. Because of poor and nonspecific symptoms diagnosis is often very difficult. This report presents a case of a 56-year-old man with right renal agenesis and intermittent hematospermia and bilateral cystic masses of the seminal vesicles. Transrectal biopsies of the cystic lesion revealed a papillary clear cell adenocarcinoma. The patient underwent radical prostatectomy and pelvic lymphoadenectomy. Lymph node metastases were found on histological examination. The patient received 4 cycles of chemotherapy and pelvic radiotherapy. He remains disease free 21 months after surgery. Radiological imaging in patients with hematospermia and hematuria will allow disease detection at earlier stages. Immunohistochemistry and histomorphology can be used for differential diagnosis. Surgery with clear margins offers the best chance to cure. Hormonal and radio-chemotherapy have a role as adjuvant and palliative treatment.

Lichen sclerosus: a review of literature and a case of an atypic surgical treatment.

Lichen sclerosus is a chronic immuno-mediated skin disease of the genital region in men and women. The treatment may be pharmacological or surgical, the choice depending on the extension of the involved area, the histological pattern and the level of functional disease complained by the patient. If the biopsy is negative for neoplastic degeneration the treatment may be pharmacological only. In our paper, we describe the case of a patient with vulvar disease and labial fusion, burial of the clitoris and severe introital stenosis. In this case, the treatment was surgical.

[Thrombosed aneurysm of a segmental renal artery branch. Diagnostic and therapeutic approach]. / Aneurisma trombizzato di un ramo segmentale dell'arteria renale: approccio diagnostico e terapeutico.

INTRODUCTION: We present the case of a 37-year-old man with a thrombosed aneurysm of a segmental branch of the left renal artery, which was diagnosed after a radiological investigation for colic-like pain, and treated conservatively with endovascular approach. MATERIALS AND METHODS: After repeated episodes of colic-like pain in his left side with normal ultrasound of the urinary tract, A.R. (37 years old) undergoes a CT urogram of the abdomen, which shows a complete thrombosis of the middle third of the left renal artery, which is associated with hypoperfusion of the lower middle third of the kidney with suspected ischemia of the lower pole. In confirmation of the previous clinical scenario, we proceed with a urgent angiography, which identifies a pseudo-aneurysm, partially thrombosed, of the segmental branch of the left renal artery at the lower middle pole. During the hospitalization, the clinical picture is complicated by an unstable arterial hypertension associated with headache and nausea. A renal scintigraphy confirms a severe impairment of the renal function mainly at the level of the middle third of the lower left kidney. The total glomerular filtration rate sec. Gates was equal to 64.3 mL/min with a percentage breakdown of the global renal function of 28% to the right and 72% to the left. The location of the vascular defect argues for endovascular intervention in the attempt to preserve the remaining renal parenchyma. We proceed with a standard angiography with selective access to the left renal artery with a catheter via femoral artery Cobra 5Fx80 TERUSMO cm. The tortuosity of the thrombus and the angle of the aneurysm site prevent, despite several attempts, the passage of the guide wire for a possible stenting and fibrinolysis. We opt for the placement of 5 spirals at the aneurysm (Boston Soft GDC-10 SR 360 7mm x 15cm), in order to preserve the residual parenchyma, excluding the aneurysmal artery at risk of rupture and extent of the thrombus. RESULTS: Immediately after the procedure, the clinical picture remained stable with complete remission of painful symptoms and with a good blood pressure control. At about 6 months, the renal scintigraphy shows a filtered global impairment of 70%, 30% for the left kidney, a slight improvement over the previous controls. The blood pressure remains within the limits with amlodipine 5 mg. CONCLUSIONS: Renal artery aneurysms are uncommon and occur in approximately 0.09% of the general population. The etiopathogenesis at a young age is often dysplastic in nature and the diagnosis is made incidentally or during evaluation of related symptoms, being asymptomatic until they become complicated. Their treatment is proposed to prevent complications such as rupture or thrombosis. Given the extreme variability of presentation, the surgical technique, traditional or endoscopic, is at the surgeon's discretion. In our case, we opted for a conservative approach since the degree of renal parenchyma impairment and the patient's hemodynamic condition allowed to.

Ureterectomy and ureteral reimplatation for low-grade transitional cell carcinoma: is the laparoscopic approach feasible and effective?

As it is well known, the gold-standard to treat ureteric and pelvi-caliceal transitional cell carcinoma (TCC) is nephroureterectomy. Nevertheless, in particular circumstances, such as solitary kidney, a more conservative treatment is needed. Conservative treatment has been reported for low-grade TCC, also. In this paper we discuss the laparoscopic approach to low-grade ureteric TCC in patients with otherwise normal urinary tract. After reporting a case of a patient treated with this approach, we deal with some technical aspect of the surgical procedure and with the pre-operative and post-operative management of the patient.

Effect of mobile unidirectional air flow unit on microbial contamination of air in standard urologic procedures.

BACKGROUND: Infection is one of the most feared complications of surgery. New instrumentation is being developed to reduce deposition of bacteria. METHODS: We investigated 45 major surgical procedures (21 radical nephrectomies [RN] and 24 radical retropubic prostatectomies [RRP]) in our urology department during 2007. In about one-half of the interventions, an ultraclean air flow mobile (UAF) unit was used. Bacterial sedimentation was evaluated by nitrocellulose membranes placed on the instrument tray and by settle plates positioned at four points in the operating room. In 27 operations, an additional membrane was located near the incision. RESULTS: Bacterial counts on the nitrocellulose membranes during RN were 230 colony-forming units (cfu)/m(2)/h with the UAF unit and 2,254 cfu/m(2)/h without the unit (p = 0.001). During RRP, the values were 288 cfu/m(2)/h and 3,126 cfu/m(2)/h respectively (p = 0.001). The membrane placed near the incision during RN showed a microbial count of 1,235 cfu/m(2)/h with the UAF unit and 5,093 cfu/m(2)/h without the unit (p = 0.002); during RRP, the values were 1,845 cfu/m(2)/h and 3,790 cfu/m(2)/h, respectively (difference not significant). Bacterial contamination detected by settle plates during RN showed a mean value of 2,273 cfu/m(2)/h when the UAF unit was used and 2,054 cfu/m(2)/h without the unit; during RRP, the values were 2,332 cfu/m(2)/h and 2,629 cfu/m(2)/h with and without the UAF unit, respectively (NS). No statistically significant differences were detected in the clinical data registered in patients operated on under standard conditions and while the UAF unit was functioning. CONCLUSIONS: The UAF appears able to reduce microbial contamination at the operating table, reaching a bacterial number obtained in ultraclean operating theatres.

Lung metastasectomy in patients with renal cell cancer (RCC). A 17-year experience in Parma Hospital.

AIM: We aim to report the results of the curative, non-palliative, treatment of resection of lung metastases that are secondary to renal cell carcinoma (RCC). METHODS: Between 1988 and 2004, a radical metastasectomy with curative purposes was performed in 20 (11 males and 9 females) patients with renal clear cell carcinoma (RCC) who had already undergone nephrectomy and subsequently metastasectomy of lung metastases. The mean age was 66,9 years (range 48-81 years). RESULTS: the intraoperative mortality of patients undergoing surgical resection of lung metastases from RCC was 0%; 17 out of 20 patients returned at follow up; 9 patients died; the mean survival-time after nephrectomy was 64+/-42 months (range 7-132 months) and the mean survival-time after metastasectomy was 31+/-29 months (range 4-99 months); 4 out of 9 pts had pulmonary recurrence after surgery. 8 patients are still alive; the mean follow up after nephrectomy was 134+/-115 months (range 30-372 months) and 72+/-44 months (range 25-150 months) after metastasectomy. 1 out of 8 pts had a pulmonary recurrence that was treated by surgery. CONCLUSIONS: the radical resection of lung metastases is a safe and effective treatment in selected RCC patients.