[Transrectal ultrasound assessment of anastomosis after videolaparoscopic radical prostatectomy: our experience]. / Il controllo ecografico transrettale dell'anastomosi dopo VLRP. La nostra esperienza.

BACKGROUND: Trans-Rectal UltraSound (TRUS) has proved to be an accurate procedure comparable to that of Fluoro-cystography (FC) to assess vesicourethral anastomosis after radical prostatectomy, with the advantages of lower costs, no radiation exposure and no dependence on the radiology department. METHODS: 60 Video Laparoscopic Radical Prostactomies (VLRP) were performed at our institution between September 2008 and January 2010. All patients underwent anatomosis assessment on postoperative day 6 with TRUS (Aloka A7 US machine with endorectal end-fire probe). 200 ml of sterile saline was manually instilled into the bladder by an assistant, while TRUS visualization of anastomosis was carried out by an urologist. The test was considered positive if any expanding anechoic shadow developed beside the anastomosis. In case of negative test the catheter was removed. In case of positive test the catheter was left in place and reassessment was performed every 5-7 days with both TRUS and FC, until negative result. RESULTS: At the initial TRUS assessment we had 4 positive and 56 negative tests. Three out of the four patients with a positive test had a second assessment on p.o. day 14, which gave a negative result. The 4th positive case had a positive second assessment on p.o. day 14 and a third negative one on p.o. day 21. In a total of 20 assessments both TRUS and FC were performed. The results of the two procedures were always in accordance. CONCLUSIONS: We have introduced TRUS assessment of vescicourethral anastomosis after laparoscopic radical prostatectomy as a routine procedure in our department. We are planning a comparative study, using FC as the gold standard, for validation purposes.

Preservation of cavernosal erectile function after soft penile prosthesis implant in Peyronie's disease: long-term followup.

The aim of this retrospective study is to evaluate the long-term followup of soft penile SSDA prosthesis, without plaque surgery in the treatment of Peyronie's disease. This study included 12 men with Peyronie's disease who underwent placement of a penile prosthesis. All patients were followed for at least 6 years. Prosthesis straightened the penile shaft in all cases, restoring patient sexual satisfaction. No operative or postoperative complications occurred, and no reoperations were needed. All patients have undergone further examination with basal and dynamic eco color Doppler. The findings are encouraging as the penis preserves the ability to enhance the tumescence and penile girth. We can conclude that SSDA penile prosthesis is safe and effective in Peyronie's disease.

Vesicoureteral reflux in the child with lazy bladder syndrome: the infrequent voider.

The Infrequent Voider Syndrome or Lazy Bladder Syndrome in children is characterized by a large capacity bladder, frequently associated with a significant volume of residual urine. Usually these patients arrive at medical examination with a history of recurrent urinary infections but without anomalies in the upper urinary tract. We report about a young girl affected by one-sided 2 degrees degree vesico-ureteral reflux due to Lazy Bladder Syndrome that had never been diagnosed before. This patient has been submitted to a prompt bladder training and seems presently to have at last gained a physiological micturition after 9 months of follow-up, without actual evidence of vesicoureteral reflux. Therefore we must stress that it is prominently important considering about infrequent micturition in a paediatric case history or a large capacity bladder, possible presence of bladder dysfunction and vesicoureteral reflux too.

Lazy bladder syndrome (the infrequent voider) causing a vesicoureteral reflux in the child.

The Infrequent Voider Syndrome or Lazy Bladder Syndrome in children is characterized by a large capacity bladder, frequently associated with a significant volume of residual urine. Usually these patients arrive at medical examination with a history of recurrent urinary infections but without anomalies in the upper urinary tract. We report about a young girl affected by one-sided 20 degree vesico-ureteral reflux due to Lazy Bladder Syndrome that had never been diagnosed before. This patient has been submitted to a prompt bladder training and seems presently to have at last gained a physiological micturition after 9 months of follow-up,without actual evidence of vesico-ureteral reflux. Therefore we must stress that it is prominently important considering every notice about infrequent micturition in a paediatric case history or a large capacity bladder, noticed by chance too. These reports may be fundamental for early diagnosis of Lazy Bladder Syndrome.

Evaluation of post-operative residual function of corpora cavernosa after soft penile prosthesis implant for Peyronie's disease.

OBJECTIVE: The aim of this study is to evaluate the results of surgical implant with a new soft penile prosthesis, called SSDA, without plaque surgery in the treatment of impotence associated with Peyronie's disease. MATERIALS AND METHODS: This study included 64 men with Peyronie's disease who underwent placement of a penile prosthesis. All the patients were followed for at least one year. RESULTS: The implant of this kind of prosthesis straightened the penile shaft in all cases, restoring sexual satisfaction to the couple, as described in a clinical interview. No operative or postoperative complications occurred and no further operations were needed. Ten patients underwent a further examination with basal and duplex dynamic color Doppler ultrasound to establish the residual function of the corpora cavernosa. DISCUSSION: The outcome is very positive: the penis preserves the ability to enhance the tumescence and the penile girth. We conclude that SSDA penile prosthesis are safe and effective in the treatment of Peyronie's disease associated with impotence.

"Ejaculatory disorders and alpha1-adrenoceptor antagonists therapy: clinical and experimental researches".

BACKGROUND: It is well known that the use of the alpha-adrenergic receptor antagonists in the BPH therapy may induce ejaculatory disorder. A review of clinical literature shows a greater incidence of ejaculatory disorder during the use of tamsulosin compared with alfuzosin. Anejaculation has been until now referred to retrograde ejaculation due to relaxation of prostatic and bladder neck smooth muscle tone. In a recent researches was evaluated the effect of tamsulosin and alfuzosin on rat vas deferent "in vitro", concluding that tamsulosin may "cause ejaculatory dysfunction by altering the progression and emission of sperm". An abnormal increase of contraction would be the cause of ejaculatory disorder. The aim of our paper is to compare human and rat vas deferens contractile activity and to evaluate with a clinical study if tamsulosin causes retrograde ejaculation disorder. METHODS: We have revaluated the human and rat vas deferens contractile activity in vitro according to our experience and literature. We have also performed a clinical study on 10 patients (48-72 y) affected by anejaculation. Post-coital urine was examined to search spermatozoa. RESULTS: Human and rat vas deferens activity is not comparable. Contractile activity induced by norepinephrin after tamsulosin incubation in rat prostatic vas deferens strips is similar to the contractile activity evoked by norepinephrin in human strips. Spermatozoa were found in post coital urine of 6 patients. CONCLUSION: In our opinion the treatment with tamsulosin may induce retrograde ejaculation but not other ejaculatory disorder due to abnormal sperm progression.

[Evaluation of FSH and Leydig cells function in patients with varicocele]. / Valutazione di FSH e funzione leydigiana nel varicocele.

The endocrine alterations in patients affected with varicocele are heterogenous in relation to some clinical aspects: orchidometry, bilateral lesion, decreased spermatozoa count and disease history. The decreased function of Leydig cells in patients affected with varicocele is related to alterations of the serotonin metabolism and to the impairment of testosterone biosynthesis. An exaggerated increase of FSH and LH after GnRH stimulation can be observed. The response to GnRH stimulation can predict a positive outcome of surgical treatment of infertile patients with varicocele. Finally it was to be emphasized the role of an increased 17 OH-progesterone/testosterone ratio and of the loss of the inverse relationship between inhibition and FSH values.