Sexual function in patients with LUTS suggestive of BPH.

BACKGROUND: Sexual function has been detected in a large sample of Italian patients affected by LUTS suggestive of BPH, by means of the ICS-Sex questionnaire. RESULTS: A number of 877 questionnaires were returned completely filled and were analyzed. Fifty percent of patients declared that their sexual life was significantly affected by their urinary symptoms. Difficulty in getting erections (58.2% of patients) and ejaculation problems (55.6%) were reported by the majority of patients, but the relevant bother was significantly different (48.3 and 33.4%, respectively). The ICS-Sex score was significantly associated with all the measures of symptoms and QoL employed in the study (IPSS and ICS-BPH). The urinary symptoms most frequently associated with sexual dysfunction were those related to incontinence. CONCLUSIONS: The QUIBUS study shows that sexual dysfunctions are commonly complained of by Italian men with LUTS and are significantly associated with urinary symptoms, in particular with urine loss. These findings support the recommendation by the 5th International Consultation on BPH to better evaluate both sexual function and incontinence symptoms in patients affected by LUTS suggestive of BPH.

[Vascular and lymphatic anatomy of the penis]. / Cenni di anatomia emo-linfatica del pene.

Anatomic considerations of the penis and its lymphatic drainage are analyzed in this issue. The precise anatomic location of the inguinal and iliac lymph nodes and the fascial planes of the femoral canal is very important to the surgeon to reduce the high morbility of lymphadenectomy.

[Carcinoma of the penis. Staging]. / Il carcinoma del pene. La stadiazione.

The two main classifications for staging carcinoma of the penis are the Jackson, which is probably the most commonly employed, and the UICC, TNM. A consistent method of staging penile cancer as been difficult, as there is no standard use of classifications. The ideal system would directly or indirectly predict the natural life expectancy of the host, the malignant potential of the tumor, the extent of the tumor and dictate the response of the tumor to treatment. Currently, using a grading system in addiction to the staging system has not improved correlation with prognosis. Prognosis appears to correlate only with stage at presentation, and the most reliable prognostic indicator of survival is the presence or absence of lymph nodes involvement at presentation.

Damage to the erectile function following radical pelvic surgery: prevalence of veno-occlusive dysfunction.

A retrospective study was carried out to investigate the prevalence of venoocclusive dysfunction (VOD) in 44 patients who developed impotence following radical cystectomy (24 patients, 55%) and radical prostatectomy (20 patients, 45%) for invasive cancer, performed using a non nerve-sparing technique. Patient evaluation included sexual history, hormone profile, intracavernosal injection test and, in the nonresponders to the test, dynamic infusion cavernosometry and cavernosography (DICC). The follow-up period investigated ranged from 6 months to 9 years and 5 months (average 2.5 years). Our data indicate a 11% prevalence (5 patients) of postsurgical VOD with impotence following radical cystectomy and a 5% prevalence (2 patients) of impotence following radical prostatectomy. In the 7 patients (5 after cystectomy and 2 after prostatectomy) who underwent DICC, cavernosal artery insufficiency was detected. No correlation was found between VOD and the time from surgery (from 6 months to 9 years, average 4.4 years), in both the post-cystectomy and post-prostatectomy groups. Our data indicate that there are not only neurogenic causes of impotence following radical pelvic surgery, VOD and cavernosal artery insufficiency can also be partly responsible. Furthermore, it was shown that erectile inactivity, even in the long-term, does not affect the possible return of drug-induced sexual potency.

[Role of intraprostatic stents in benign prostatic hypertrophy]. / Il ruolo degli stents endoprostatici nell'ipertrofia prostatica benigna.

We report our indications and experience in the use of intraprostatic endoprosthesis. We report also our preliminary experience in the use of a new intraprostatic endoprosthesis which has been developed at our institute. This prosthesis can be easily positioned, shows little invasiveness and does not require ultrasonic, radiological or endoscopical guidance.

[Sex-dynamic characterization of patients subjected to radical pelvic cavity surgery]. / La caratterizzazione sessodinamica nei pazienti sottoposti a chirurgia radicale dello scavo pelvico.

A retrospective study was carried out using sexual case histories, hormonal profiles, vasoactive drugs test, dynamic cavernosometry and cavernosography on 46 patients who underwent radical cystectomy (26 patients: 57%) and radical prostatectomy (20 patients: 43%) for neoplasia, conducted by means of traditional surgical non-nerve sparing methods, in order to characterize the type of damage affecting the erectile function as a result of surgery. The study was carried out at a minimum of 2 months, a maximum of 9 years and 5 months, an average of 2 years and 6 months, after surgery. One patient (2%) reported intact erectile function and withdrew from the study. 37 patients (80%) showed neurological damage, while the remaining 8 (18%) had prevalently vascular damage.

[Ureteritis]. / Le ureteriti.

We relate our experience about ureteritis, especially non specific ureteritis. The traumatic, radiation ureteritis will be discussed in others chapters. Most cases of ureteritis are infective, and may be due to any of the organism normally found in urinary tract infections, particularly Escherichia Coli, staphylococci, streptococci, enterococci, proteus and pyocyaneus. It is really primary, but it usually ascending from an associated cystitis, descending from pyelonephritis, or due to direct spread from and adjacent inflammatory lesion such as appendicitis or salpingitis. The infection may also reach the ureter by lymphatic spread, particularly from the prostate and seminal vesicles. Any associated abnormalities of the ureter, such as stricture, megaloureter, ureterocele, and so on, will naturally predispose to infective ureteritis. As ureteritis is rarely primary, the first step in treatment must be toward the elucidation and cure of any underlying lesion. Thus calculi, cystitis, pyelitis, and so on, will need appropriate therapy, and this in itself will considerably improve or cure the ureteritis, and specially in the more acute cases. In the chronic cases with stricture formation, dilation or even excision of the stenosed portion may be required. For the treatment of the strictures we want emphasize the role of the ureteral stenting thinking its use is necessary to preserve the renal function.

[Controversies on the subject of traumatic lesions of the ureter]. / Controversie in tema di lesioni traumatiche dell'uretere.

The injuries to the ureter, whether from external trauma or iatrogenic, are rare. Some problems are common to this type of pathology, independently from the causes of injuries. It is necessary a prompt diagnosis of the lesion to avoid the urinar leakage, the infection and the fibrosis of the ureteral's stumps. If the diagnosis is not prompt, the clinical pattern may be silent for some days; after, many complications will arise up: sepsis, urinomas and fistulas. When the lesion is incomplete, and there is no devascularization, the urine drainage alone, positioned above the level of the lesion, is indicated for spontaneous repairing. When the ureteral tissue loss is extensive, it is not enough a simple anastomosis between the ureteral's stumps; in these cases is necessary a more complex repair surgery or ureteral substitution.

[Bladder neck cysts: role of transrectal echography]. / Cisti del collo vescicale: ruolo dell'ecografia transrettale.

High frequency probes for transrectal sonography are well tolerated and permit us to study the cervico-urethral unit carefully. We are allowed to single out some rare causes of obstruction, otherwise difficult to diagnose. Bladder neck obstruction secondary to a cyst is one of these. Our case report is about a young patient with complete retention secondary to bladder cyst discovered by transrectal sonography.

[Echography versus nuclear magnetic resonance in the preoperative dynamic evaluation of plastic penile induration]. / Ecografia versus risonanza magnetica nucleare nella valutazione dinamica preoperatoria dell'induratio penis plastica.

Recently Ultrasonography (US) and Magnetic Resonance Imaging (MRI) has been successfully used as painless and non invasive techniques for depicting dense fibrous connective tissue of Peyronie's Disease (PD). The purpose of this study is to demonstrate the extent of disease and to prove the accuracy of US versus MRI. Twenty patients (aged 20-70; mean 43) with clinical diagnosis of PD were studied. All patients were studied with flaccid and erected penis after an intracavernous injection of Papaverine (variable dose). US and MRI examinations were performed independently by 2 groups of observers who knew clinical findings but not the results of the other technique. Both methods gave satisfactory images: they show the capacity to depict and to measure Peyronie's plaques clinically appreciated. US in 4 patients and MRI in 3 patients identified not palpable lesion which infiltrate the septum. Although the most common area of PD involvement is the dorsal surface of tunica albuginea, sometimes fibrous plaques are along the septum between the corpora cavernosa and the corpus spongiosum. In the present study, US and MRI are too able to identify not palpable lesion in the septum. In our opinion US has to be used for its high accuracy and low cost.