Efficacy of spermatic vein ligation in patients affected by high grade left varicocele.

PURPOSE: To study the effect of high grade varicocele treatment in infertile patients. MATERIALS AND METHODS: Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the subject's partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period. RESULTS: Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10(6)/mL compared to 19.7x10(6)/mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001). CONCLUSION: Surgical treatment of high grade varicocele proved to effectively treat associa¬ted infertility by improving seminal parameters and pregnancy rate in our patient cohort.

Efficacy of spermatic vein ligation in patients affected by high grade left varicocele

Purpose: To study the effect of high grade varicocele treatment in infertile patients. Materials and Methods: Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the subject’s partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period. Results: Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10 6 /mL compared to 19.7x10 6 /mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001). Conclusion: Surgical treatment of high grade varicocele proved to effectively treat associated infertility by improving seminal parameters and pregnancy rate in our patient cohort. .

The role of bladder neck preservation during radical prostatectomy: clinical and urodynamic study.

AIMS: Bladder neck preservation has caused an increase in urinary continence following radical prostatectomy, and has given rise to much controversy. We have reviewed our clinical and urodynamic experience collected since 1995 in patients subjected to radical prostatectomy with bladder neck preservation. MATERIALS AND METHODS: 180 patients were followed postoperatively using a pad test, an incontinence questionnaire and PSA dosage. In 66 early continent patients, test of maximum urethral closing pressure, functional length and active urethral continence were carried out, together with Valsalva leak point pressure tests and a pressure/flow study. The obtained data were then analysed. RESULTS: Urinary continence was achieved in 132/180 men (73%) already two weeks after operation. Three months, six months and one year later the continence rate was 89%, 95.5% and 97.7% (176/180) respectively. As far as the urodynamic parameters of the 66 patients fully tested are concerned, all showed high results. The active urethral continence capacity exceeded 200 cm/water, and the Valsalva leak point pressure equalled or exceeded 150 cm/water. CONCLUSIONS: Following an accurate dissection of the distal urethra, bladder neck preservation guarantees early recovery of continence, as confirmed by local urodynamic figures, and restores functional integration of both the urethral sphincteric-smooth proximal and distal striated units.

Leydig cell tumour of the testis: presentation, therapy, long-term follow-up and the role of organ-sparing surgery in a single-institution experience.

OBJECTIVE: To report our single-centre experience of patients with Leydig cell tumour (LCT) of the testis, which represents the most frequent interstitial neoplasm of the testis, and for which the natural history and therapy are debated. PATIENTS AND METHODS: Between 1990 and 2006, 37 patients were treated for LCT of the testis. All patients had testicular markers assessed and 21 (57%) had their hormonal profile assessed (total testosterone, follicle-stimulating hormone, luteinizing hormone and oestradiol). We analysed the symptoms at presentation, laboratory findings, organ-sparing vs. radical surgery and oncological and symptomatic follow-up data. RESULTS: Medical referral was for a testicular mass in 32% of patients, gynaecomastia in 8%, testicular pain in 8%, infertility in 11%, and isosexual pseudo-puberty in 5%. The mean (range) diameter of the tumour was 16.5 (6-68) mm. Before surgery testosterone levels exceeded the upper limit in a third of patients, while levels were hypogonadal in 19%. Oestradiol levels were increased in 29% of patients. At surgery, 29 patients (78%) had organ-sparing surgery. The median (range) follow-up was 4.6 (0.6-16.2) years; no patient had disease relapse. Gynaecomastia was present in two of six patients at the follow-up, despite pharmacological treatment. Four patients had a low testosterone level. CONCLUSION: Patients diagnosed with LCT have a good prognosis; this study shows the safety of conservative surgery. Surgical removal of the tumour is not always associated with resolution of symptoms and abnormal laboratory values.

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.

The natural history of Peyronie's disease.

OBJECTIVE: Many physical or medical therapeutic approaches, systemic or local, have been suggested for treatment of Peyronie's disease. These approaches claim a discrete percentage of success in terms of clinical stabilization or improvement. The aim of our work was to evaluate the "natural history" of this disease. METHOD: 110 patients affected by Peyronie's disease have been observed for at least five years. At the first visit all patients maintained sexual activity not requiring surgical approach. No medical or physical treatments have been performed on these patients. All patients underwent twelve months follow up for at least 5 years evaluating the natural progression of the disease by means of ultrasound and clinical examination. We made statistical analysis (Odds ratio, P for trend) to check if there is association between clinical worsening requiring surgical treatment and: 1- age of patients, 2- diabetes, 3- presence of close relative pattern for diabetes and 4-Dupuytren contracture. RESULTS: Regarding curvature, number and size of fibrous plaques, a consistent tendency to stabilization has been observed in the group of patients above 50 years of age. 68% of the patients belonging to the group under 50 years showed a progressive worsening of the disease requiring surgical therapy, while in the other group only 31,5% of the patients required surgery. The statistical analysis confirmed that PD worsening is more probable in the group under 50 years of age (OR=3.5, CI:2-8) and in the patients affected by diabetes (age adjusted OR=6, CI:2-19). Statistical analysis has not shown significant differences in the evolution of Peyronie's disease regarding the presence of close relative pattern for diabetes and Dupuytren contracture. CONCLUSION: The patients presented a discrete tendency to spontaneous stabilization. The patients who are diagnosed under the fifties have a greater probability that the disease will worsen, requiring a surgical approach. The data regarding the natural history of Peyronie's disease in not treated patients should induce caution in awarding efficacy to new pharmacological and physical treatments.

The natural history of peyronie’s disease / Historia natural de la enfermedad de La Peyronie

Objetive: Many physical or medical therapeutic approaches, systemic or local, have been suggested for treatment of Peyronie's disease. These approaches claim a discrete percentage of success in terms of clinical stabilization or improvement. The aim of our work was to evaluate the «natural history» of this disease. Method: 110 patients affected by Peyronie's disease have been observed for at least five years. At the first visit all patients maintained sexual activity not requiring surgical approach. No medical or physical treatments have been performed on these patients. All patients underwent twelve months follow up for at least 5 years evaluating the natural progression of the disease by means of ultrasound and clinical examination. We made statistical analysis (Odds ratio, P for trend) to check if there is association between clinical worsening requiring surgical treatment and: 1- age of patients, 2- diabetes, 3- presence of close relative pattern for diabetes and 4-Dupuytren contracture. Results: Regarding curvature, number and size of fibrous plaques, a consistent tendency to stabilization has been observed in the group of patients above 50 years of age. 68% of the patients belonging to the group under 50 years showed a progressive worsening of the disease requiring surgical therapy, while in the other group only 31,5% of the patients required surgery. The statistical analysis confirmed that PD worsening is more probable in the group under 50 years of age (OR=3.5, CI:2-8) and in the patients affected by diabetes (age adjusted OR=6, CI:2-19). Statistical analysis has not shown significant differences in the evolution of Peyronie's disease regarding the presence of close relative pattern for diabetes and Dupuytren contracture. Conclusion: The patients presented a discrete tendency to spontaneous stabilization. The patients who are diagnosed under the fifties have a greater probability that the disease will worsen, requiring a surgical approach. The data regarding the natural history of Peyronie's disease in not treated patients should induce caution in awarding efficacy to new pharmacological and physical treatments (AU)

Objetivo: Para el tratamiento de la enfermedad de La Peyronie se han sugerido muchos abordajes terapéuticos físicos y médicos, sistémicos y locales. Estos tratamientos suponen un discreto porcentaje de éxitos en términos de estabilización clínica o mejoría. El objetivo de nuestro trabajo es evaluar la historia natural de esta enfermedad. Métodos: 110 pacientes con enfermedad de La Peyronie fueron observados durante al menos cinco años. En la primera visita todos los pacientes mantenían actividad sexual y no tenían indicación para un abordaje quirúrgico. No se hizo tratamiento médico físico en estos pacientes. Todos los pacientes fueron seguidos de anualmente durante al menos cinco años, evaluando la progresión natural de la enfermedad por medio de ultrasonidos y exploración física. Realizamos un estudio estadístico (Odds ratio, P ) para comprobar si existía asociación entre el empeoramiento clínico que requiriera cirugía y: 1-la edad del paciente; 2-diabetes; 3- un patrón de diabetes en la familia próxima; y 4-enfermedad de Dupuytren. Resultados: En relación con la curvatura y el número y tamaño de las placas fibrosas se ha observado una tendencia hacia la estabilización del grupo de pacientes de más de 50 años de edad. El 68% de los pacientes del grupo de edad menor de 50 años mostraron un empeoramiento progresivo de la enfermedad requiriendo cirugía, mientras que en el otro grupo sólo el 31,5% de los pacientes necesitaron cirugía. El análisis estadístico confirmó que el empeoramiento de la enfermedad es más probable en el grupo menor de 50 años de edad (OR= 3,5, IC 2-8) y en los pacientes diabéticos (ajustando por edad OR = 6, IC 2-19). El análisis estadístico no ha mostrado diferencias significativas en la evolución de la enfermedad de Peyronie en cuanto a la presencia de un patrón de diabetes en los familiares cercanos o de enfermedad de Dupuytren. Conclusiones: Los pacientes presentaron una discreta tendencia hacia la estabilización espontánea. Los pacientes diagnosticados antes de los 50 tiene una mayor probabilidad de empeoramiento de la enfermedad requiriendo un abordaje quirúrgico. Los datos sobre la historia natural de la enfermedad de Peyronie en pacientes no tratados deben transmitir cautela a la hora de considerar la eficacia de los nuevos tratamientos farmacológicos y físicos (AU)

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.

Reduction in PSA messenger-RNA expression and clinical recurrence in patients with prostatic cancer undergoing neoadjuvant therapy before radical prostatectomy.

BACKGROUND: We assessed the incidence of micro-metastases at surgical margins (SM) and pelvic lymph nodes (LN) in patients submitted to radical retropubic prostatectomy (RP) after neoadjuvant therapy (NT) or to RP alone. We compared traditional staging to molecular detection of PSA using Taqman-based quantitative real-time PCR (qrt-PCR) never used before for this purpose. METHODS: 29 patients were assigned to NT plus RP (arm A) or RP alone (arm B). Pelvic LN were dissected for qrt-PCR analysis, together with right and left lateral SM. RESULTS: 64,3% patients of arm B and 26.6% of arm A had evidence of PSA mRNA expression in LN and/or SM. 17,2% patients, all of arm B, had biochemical recurrence. CONCLUSIONS: Qrt-PCR may be more sensitive, compared to conventional histology, in identifying presence of viable prostate carcinoma cells in SM and LN. Gene expression of PSA in surgical periprostatic samples might be considered as a novel and reliable indicator of minimal residual disease after NT.

[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.

Neoadiuvant Treatment With Intravesical Interleukin-2 for Recurrent Superficial Transitional Bladder Carcinoma Ta-T1/G1-2.

SUMMARY: The aim of this study was to evaluate the direct action of IL-2 on recurrent superficial transitional bladder carcinoma and the effect on recurrence rate. 27 patients were submitted to neoadjuvant treatment by intra-vesical instillation of recombinant IL-2 and to transurethral resection. We did not observe any effect on neoplasms but the recurrence rate was less than the expected one. It is possible that treatment of bladder carcinoma with intra-vesical instillation of IL-2 may promote immuno-prophilaxis.