[Male cervico-urethral obstruction of organic cause: transrectal prostatic ultrasonography versus permicturition and urethral ultrasonography]. / Ostruzione cervico-uretrale maschile da causa organica: ecografia prostatica transrettale versus eco perminzionale ed uretrale.

AIM: This paper reports personal experience relating to the use of "static" and "permicturition" prostatic transrectal ultrasonography and urethral ultrasonography in the imaging diagnosis of obstructed patients. METHODS: Between January 1996 and January 1998 we selected 96 consecutive patients aged between 25 and 73 years old (mean 54 years) with symptoms of obstructive dysuria with pathological uroflowmetry and pressure/flow rates (Qmax ranging between 5-12 ml/sec and URA between 34-81). Eighteen of the patients selected had previously undergone prostate surgery for benign pathologies. All patients underwent a standard and permicturition transrectal ultrasonography and urethral ultrasonography using a retrograde approach. The results were compared with those obtained by retrograde urethrocystography and urethrocystoscopy, regarded as the "gold standard" for the diagnosis of urethral obstruction. RESULTS: Sixty-three (65.5%) patients were able to execute the permicturition phase, but only 54 (56.2%) reported that the test was indicative of "real urination", whereas retrograde urethral ultrasonography was well tolerated in all cases and easy to accomplish. In 19 (20%) patients (6 of whom had undergone prostate surgery and 13 were suffering from urethral stenosis), "major" organic alterations responsible for urethral obstruction were observed with the combined use of these ultrasonographic methods. These were not evident using static transrectal ultrasonography and increased the diagnostic sensitivity from 80 to 98%. CONCLUSIONS: We feel that an increasingly complete ultrasonographic study of the lower urinary tract is necessary, above all in obstructed patients. This can be achieved using permicturition and urethral transrectal ultrasonography, ensuring an accurate diagnosis and optimising health expenditure.

[Screening for prostatic carcinoma in dysuric patients: diagnostic protocols and cost-benefit analysis]. / Screening del carcinoma prostatico in pazienti disurici: protocolli diagnostici e rapporto costi/benefici.

This work deals with our experience of a programme of early diagnosis of prostate cancer carried out on patients suffering from dysuria through rectal-digital examination (EDR), hematic dosage of PSA (IRMA COAT-A-COUNT DPC) and transrectal echtomography. We have also quantified the costs and verified which methods, either single or combined with other methods, are most advantageous as regards costs/benefits. From Jan 1991 to Jan 1995 306 of 1185 patients (25.8%) underwent prostate biopsy by means of transperineal echograph with gauge 18 needles as in Hodge's technique. Histologic examination revealed prostate adenocarcinoma in 81 (26.5%) cases, benign prostate hypertrophy in 196 (64%), acute and/or chronic phlogosis in 26 (8.5%) and granulomatosic prostatitis in 3 (1%). The diagnostic sensitivity, preciseness and accuracy were, respectively, 92.5%, 78.3%, 79.3% for the EDR, 80.2%, 93.3% and 90% for PSA with cut-off 10 ng/ml, 91% 78.3%, and 90% for the PSA with cut-off 4 ng/ml, 100%, 30.3% and 48.6% for the echograph, 98.8%, 60% and 77% for EDR+PSA (cut-off 4 ng/ml), 98.8%, 65.8 and 79.9% for EDR+PSA (cut-off 10 ng/ml), 100%, 22% and 64.2% for EDR+echograph, 100%, 20% and 62.9% for echograph+PSA (cut-off 4 ng/ml), 100%, 26.6% and 64.9% for echograph+PSA (cut-off 10 ng/ml). We calculated that a programme of early diagnosis using the three methods, if completely at the patient's expense, would cost 207.000-437.000 lire (average 322.000) per patient for a total of 245,295,000-517,845,000 (average 381,570,000). An eco-guided prostate biopsy with a histologic examination would cost 250.000-500.000 lire (average 375.000) per patient with a total cost for 306 patients of 76,500,000-153,000,000 (average 114,750,000). We also quantified, in the light of the results reported here, the number of biopsied which would have been necessary if we had used only two methods in the screening and we also estimated the costs. The results reveal that the echograph is not to be considered as a first approach method as it gives a high number of false positive results; in fact if we had excluded it from the screening we would not have ignored any diagnosis of prostate neoplasia and we would have avoided about 141 (46.2%) biopsied with a reduction in health expenditure of 62.1%. On the contrary the EDR and the PSA have a better cost/benefit result: setting the cut-off of the PSA at 4 ng/ml or at 10 ng/ml without varying the diagnostic accuracy, the sensitivity and/or specificity of the method increase respectively. To conclude, we consider the EDR and the serum dosage of PSA necessary and adequate methods in the programme of early diagnosis and screening of prostate neoplasy. The prostate echography should be reserved for cases of doubt (hematic PSA between 4-10 ng/ml etc.) and for the exclusion of needle biopsy. These measures also result in an optimization of health expenditure.

[Stress urinary incontinence in women. Our experience with 218 cases]. / Incontinenza urinaria da sforzo nella donna. Nostra esperienza in 218 casi.

From November 1992 to March 1994, in the Gynaecological ward of the Obstetrical and Gynaecological section of Cannizzaro Hospital, 218 patients suffering from urinary stress incontinence (U.S.I.) were observed. Using computerized clinical cards, U.S.I. was found in the 71.79% cases. From the clinical evaluation 38.39% of patients were found to be suffering from 1st degree bladder prolapse, 34.82% from 2nd degree bladder prolapse and 16.97% from, 3rd degree. 9.82% of the patients did not manifest signs of bladder prolapse. Therapy was mainly surgical. Burch colposuspension was carried out on 65 patients. When necessary a total hysterectomy and perineal plastic surgery was carried out. A Perrin-Leger bladder neck suspension was carried out on 10 patients and a Pereyra-Raz on 5. Given the varied aspects of U.S.I., the Authors would conclude that the best results are obtained by combining medical, surgical and rehabilitative treatment.

[Volocimetric evaluation of spermatic vessels with echo color doppler in patients with idiopathic varicocele]. / Valutazione velocimetrica delle arterie spermatiche mediante eco color-Doppler in pazienti affetti da varicocele idiopatico.

BACKGROUND AND AIMS: There is a high incidence of varicocele or dilatation of the spermatic vessels associated with reflux in the male population varying, according to statistics, from 4.5 to 30.7%. Among the numerous hypotheses put forward to explain infertility in approximately 50% of patients with varicocele, it has recently been shown that there is an increased concentration of noradrenalin in the spermatic vessel which might be responsible for chronic arterial vasoconstriction affecting the gonads, leading to endothelial hyperplasia and consequent infertility. MATERIALS AND METHODS: In this study the authors have evaluated the bilateral flow of spermatic arteries at the level of the scrotum in patients with varicocele and in the healthy (varicocele-free) population with normal and hypospermatogenesis. RESULTS: In all groups and in the absence of other major pathologies (including arterial hypertension), no significant differences were found in systolic peak velocity (SPV) in relation to the presence or otherwise of varicocele and the degree of reflux. Mean SPV ranged between 3.5 and 4 cm/sec in patients with hypo- and/or normal zoospermia both in the varicocele and healthy population. CONCLUSIONS: In line with other authors, we feel that despite the lack of substantial differences in arterial flow in the patients examined, it is not possible at present to explore the testicular microcirculation and possible hypoperfusion using eco color-Doppler, in spite of the fact that the method shows a high level of diagnostic accuracy in the diagnosis of phlogistic pathologies and/or twisting of the spermatic cord. New approaches might be provided through the improved study of the microcirculation using power Doppler which appears to be more sensitive than eco color-Doppler in visualizing small intraparenchymal vessels.

[PSA and prostatic adenocarcinoma. Experience with 805 patients]. / PSA ed adenocarcinoma prostatico.

Over the last decade PSA has been widely acknowledged to be a very sensitive and specific marker of prostatic tumour pathologies. This paper reports the authors' experience relating to the use of PSA in the early diagnosis of prostatic heteroplasia on the basis of results obtained in a study performed in 805 dysuric patients who underwent rectal exploration and CAT. Echo-guided prostate biopsy according to Hodge was performed in 212 (26.4%) out of 805 patients and adenocarcinoma was found in 55 cases (25.9%). PSA ranged between 10-198 ng/ml in 42 out of 212 patients, between 4-10 ng/ml in 60, and was below 4 ng/ml in 110. In addition, PSAd was assayed in all patients with PSA < 10 mg/ml. Having established the cutoff of PSA at 10 ng/ml, it was found that some heteroplasia, above all at the initial sage, presented normal PSA blood values. In fact, in 8 cases, equivalent to 14.5% of the neoplasias diagnosed, values were under 4 ng/ml, and in 5 cases, equivalent to 9%, they ranged between 4-10 ng/ml. This finding showed that the threshold value of 10 ng/ml gives PSA a high specificity, but a lower sensitivity in the early diagnosis of prostatic adenocarcinoma. Moreover, the analysis of PSA-density does not significantly allow the diagnosis of a larger number of heteroplasias: in fact, out of 13 cases of adenocarcinoma with PSA < 10 ng/ml, PSAd was only > 0.15 in 2 patients. Therefore, in line with the data reported in the literature, the authors consider that PSA assay represents a sensitive and specific screening method for prostatic tumour pathologies in symptomatic patients, but in order to obtain an early diagnosis, and especially in cases with serum values between 4-10 ng/ml, it must be combined with both rectal exploration and, above all, transrectal scan.

[The role of TPS in the diagnosis of prostatic carcinoma]. / Ruolo del TPS nella diagnosi del carcinoma prostatico.

From June 1993 to July 1994 we treated 136 male patients affected by dysuria with hematic dosage of TPS and PSA, with DRE, transrectal echography and prostatic biopsy using an echograph. The patients treated were divided into two groups: A and B. Group A (TPS cut-off of 75 U/l) was made up of 91 patients, ages ranging from 41 to 85 years (average 72.5 years). Group B (TPS cut-off > 75 U/l) was made up of 45 patients, ages ranging from 39 to 88 years (average 75.1 years). In group A, 22 patients (24.2%) resulted as suffering from prostatic carcinoma, 4 (4.3%) resulted as suffering from prostatic phlogosis, and 65 (71.4%) resulted as suffering from BPH. In group B, 6 (13.3%) were affected by prostatic heteroplasia, 2 (4.4%) were affected by prostatic phlogosis, and 37 (82.2%) were affected by BPH. The TPS had a sensibility of 21.4% and a specificity of 66.3%. A comparison of the data obtained in the two groups did not reveal any significant differences. In this study the TPS showed a poor diagnostic reliability as a biologic marker of prostatic carcinoma.

[Ultrasonography and prostatic adenocarcinoma]. / Ecotomografia ed adenocarcinoma prostatico.

In the report we refer to our experience as regards the role of transrectal ultrasonography in the early diagnosis of prostatic heteroplasia based on the results obtained by a research led from January 1991 to January 1995 on 1185 dysuria patients who have been subjected also to a rectal exploration and a serous dosage of PSA. Among the 306/1185 (25.8%) of the patients subjected to prostatic echoguided biopsy sec. Hodge in 238 (77.7%) a hypoechogenic zone on behalf of the periphery of the prostatic parenchyma has been reported. The histological result has pointed out the presence of adenocarcinoma in 81 (26.4%) patients; of benign prostatic hypertrophy in 196 (64%); of acute and/or chronic non specific phlogosis in 26 patients (8.4%) and granulomatosis prostatitis in 3 (1%). The sensibility, the specificity and the diagnostic efficiency of the transrectal ultrasonography in the diagnosis of prostatic heteroplasia have resulted equal, respectively to 100%, to 30.2% and to 48.6%. In 122 patients (66%) the hypoechogenic zone was not pathognomonic of prostatic heteroplasia. Definitely, considering the high sensibility in opposition to the insufficient specificity of the echography, it is our future intention not submit to prostatic biopsy those patients who show only a hypoechogenic zone in absence of pathology EDR and PSA but to monitor them through quarterly clinic checks.

[Rehabilitation therapy in the treatment of female urinary incontinence. Our experience with 121 patients]. / La terapia riabilitativa nel trattamento dell'incontinenza urinaria femminile. La nostra esperienza su 121 pazienti.

Rehabilitative therapy of the perineum (FKT, SEF and biofeedback) represents an efficient method in the treatment of urinary stress incontinence without resorting to a complete uro-genital prolapse, as in patients with urethral instability and/or incontinence. One hundred twenty-one women, 55 with urinary stress incontinence (USI), 20 with urge incontinence (UI) and 46 suffering from both types of incontinence, underwent rehabilitative therapy. On each patients the following tests were carried out: an internal test, a urodynamic test (uroflowmeter, PPU, cystomanometry and pessure/flow study), a meter UEC, situated at the bladder neck, anterior and posterior urethra, both clinostatic and orthostatic, urine test with urinoculture and a pap-test. The aim of this study is that of establishing if it is possible a) to simplify the rehabilitative sitting using only FKT with weekly treatment; b) to treat women suffering from urge incontinence or from both types, but with bladder stability (standard cystomanometria) with FKT and Ditropan (1 tablet 3 times daily for weeks therapy). One group of patients underwent rehabilitative therapy while another group underwent traditional therapy, for a minimum of 12 sitting, using also electric functional stimulation (SEF). Of 121 women who underwent rehabilitative therapy, 90 (74.4%) were healed, 30 (24.7%) improved and one (0.9%) showed no signs of improvement. Patients treated with FKT, or FKT and made as good if not better grogress than those who attended more sittings and/or underwent SEF.(ABSTRACT TRUNCATED AT 250 WORDS)