[Ultrasonographic study of detrusor thickness in patients with obstruction]. / Studio ecografico dello spessore del detrusore nel paziente ostruito.

The diagnostic work up of patients with symptomatic benign prostatic hyperplasia is not always useful for diagnosing bladder outlet obstruction, especially if they are compared with pressure-flow studies. The authors make a review of the literature and a clinical study to demonstrate that alternative less invasive methods (ultrasound estimated bladder weight) can often replace pressure/flow studies.

[Management of sexual disorders in the diabetic patient. Considerations on diagnosis and therapy based on current pathogenetic and physiopathologic knowledge]. / La gestione dei disturbi sessuali nel diabetico. Considerazioni in tema di diagnosi e terapia alla luce delle attuali conoscenze patogenetiche e fisiopatologiche.

The sexual disorders in the diabetic males are quite frequent, particularly the erectil failures, which involve about 50% of these subjects. After a brief epidemiological note, the Authors review the recent advances about the pathogenesis of such a disturbance in the International Literature: values and limitations of up-to-date diagnostic examinations as well as therapeutic options are critically considered. From the diagnostic point of view the progress of the techniques involved both in the study of penile microcirculation and in the neurophysiopathology of the pelvic autonomic nervous system must be emphasized. Furthermore the great efficacy (up to 90% of satisfactory results) of vasoactive intracorporeal injections has to be stressed.

[Vesico-urethral and entero-urethral anastomosis: anatomo-surgical considerations and technical note]. / Anastomosi vescico-uretrali ed entero-uretrali: considerazioni anatomo-chirurgiche e note di tecnica.

Following radical prostatectomy or radical cystectomy with orthotopic ileal bladder (in male patients), the cervico-urethral or entero-urethral anastomosis are at high risk for urinary stress incontinence, due to the shortening of the urethral functional length as well as "unavoidable downward fall" of the perineum after sectioning of the anterior portion of the sacro-pubic ligaments. That descensus of the perineum, if uncorrected, might cause a functional extraabdominal positioning of the residual functional urethra; this feature is close similar to one of the most important pathogenetic factors of genuine stress incontinence in the female. In order to correct that perineal fall is advisable to perform the so-called "secondary sphincter" (after Rocca Rossetti, 1982) by suturing with the same stitches not only the anastomotic edges but the medial part of the levator ani (i.d. pubo-rectal muscles) and the retro-urethral striated musculature as well; this technique ensure a good intraabdominal position of the residual functional urethra and prevents dangerous tensions on the anastomosis. The Authors stress the importance of a delicate dissection of the prostatic apex with no or minimal manipulation of the membranous urethra avoiding to evaginate it from the surrounding pelvic floor, that could damage its vascular supply. Following the before mentioned criteria the Authors performed 17 radical prostatectomies and 7 ileal bladder after radical cystectomy with satisfactory results (4.1% of postoperative urinary incontinence).

[Radical prostatectomy: role of ultrasonography in the follow-up]. / Prostatovesciculectomia radicale: ruolo dell'ecografia nel follow-up.

After a brief summary about surgical technique of radical prostatectomy and its indications in the different stages of prostatic cancer, the Authors describe complications and surgical sequelae of this operation. The Authors report a brief series. It is composed with 13 patients. Their have been submitted to radical prostatectomy for prostatic cancer between January 1989 and September 1991. Pathological stage was B1 in 6 patients, B2 in 2 patients, C1 in 4 cases and C2 in 1. Particularly the role of ultrasonography in detection and follow-up of early complications such as lymphocele, pelvic hematoma and anastomotic urine leakage is stressed. Transrectal ultrasound is especially useful in the detection of urine leakage from vesico-urethral anastomosis. This technique is compared with traditional cystourethrography and advantages and disadvantages of the two techniques are discussed. Later complications of radical prostatectomy are anastomotic stenosis, pelvic recurrences, nodal or parenchymal metastasis, urinary incontinence. The role of transrectal ultrasound in the detection of anastomotic strictures is stressed, especially when the study is done during micturition. Transrectal ultrasound is not so satisfying in the detection of pelvic recurrences, especially if they are smaller than 1 cm. In case of large masses digital examination is diagnostic itself. At last the Authors describe urinary incontinence and its etiology as a complication of radical prostatectomy. Particularly a surgical technique for vesico-urethral anastomosis proposed by Rocca Rossetti and its value in post-operative continence is described. The Authors show the results of transrectal ultrasound in the detection of striated urethral sphincter and its function after radical prostatectomy.

Immunophenotypic characterization of the bladder mucosa infiltrating lymphocytes after intravesical BCG treatment for superficial bladder carcinoma.

The lymphocytes infiltrating the bladder mucosa of 28 patients treated with bacillus Calmette-Guérin (BCG) for superficial bladder carcinoma were characterized using an immunohistochemical technique on frozen sections of biopsy specimens obtained during cystoscopy. The inflammatory response induced by BCG consisted mainly of T lymphocytes (CD3+), most of which had the helper/inducer phenotype (CD4+), with a CD4/CD8 ratio greater than 1. A minor subset of lymphocytes were of B phenotype (CD22+). These findings persisted for the whole follow-up period (6-12 months) in spite of a progressive decrease of the inflammatory infiltrate. No difference in the lymphocyte phenotype was observed between nonresponding patients and those who responded to BCG in the short term. It is concluded that, although intravesical BCG therapy does affect the immunocompetent cells of the bladder wall, the BCG-induced antitumor activity is unlikely to depend exclusively on a local immune mechanism.

[Mono-symptomatic hematuria: first symptom of metastatic pulmonary carcinoma]. / Ematuria monosintomatica: primo sintomo di carcinoma polmonare metastatico.

The occurrence of secondary bladder neoplasms is very uncommon, especially when the bladder is the only site of metastasis. The Authors report on one case of bladder metastasis from primary small cell carcinoma of the lung.

[Cystic nephroma: report of two cases and review of literature]. / Nefroma cistico: nostra esperienza su due casi e revisione della letteratura.

Cystic nephroma is an uncommon lesion, whose etiology and pathogenesis is still debated: some Authors designate it as being of neoplastic origin, other ones of dysplastic or hamartomous origin. Also epidemiology makes difficult its pathogenetic interpretation, as being especially affected children under age of fourth year and adults within the 5th and 6th decade. The Authors report two cases of cystic nephroma examined in two female patients 30 and 74 aged. The most interesting matters are: 1) Possibility of a pre-operative diagnosis of founded suspicion, based on pathologic criteria, codified in literature (unilateral and multilocular cyst which doesn't communicate with the renal collecting system, separated by delicate septae without mature renal tissue) and on respective ultrasonographic, CT and angiographic patterns; 2) Possibility of programming a surgical-conservative strategy; 3) Knowledge about possibility of foci association of adeno-carcinoma or nephroblastoma in the lesion, that, nevertheless, if not widespread, it should not modified neither therapeutical proceeding nor prognosis, generally favourable.

[Inverted papilloma associated with transitional cell carcinoma in the upper urinary tract: report of one case and review of the literature]. / Associazione di papilloma invertito e carcinoma uroteliale nell'alta via escretrice: presentazione di un caso e revisione della letteratura.

Inverted papilloma of the pelvis and the ureter is a rather uncommon (only 40 cases in the relevant literature) benign epithelial tumor, occasionally harboring foci of malignancy. Since it does not metastasize, a conservative treatment is advisable, but a strict follow up is always required. The Authors report a case of inverted papilloma of the ureter near which an area of transitional carcinoma was discovered.

[Extrinsic ureteral endometriosis: description of a case]. / Endometriosi ureterale estrinseca: descrizione di un caso.

After a brief review about pathogenetic hypothesis of the endometriosis of the ureter, the Authors describe a case occurred to their observation. Diagnostic problems and choice in treatment (especially partial ureterectomy, end-to-end ureteral anastomosis and omentoplasty) are discussed.

Correlation between liver cirrhosis and benign prostatic hyperplasia: a morphological study.

In elderly males hormonal changes occur, that are believed to cause benign prostatic hyperplasia (BPH). These are decreased testosterone production, an increased testosterone SHBG and a slightly increased estradiol production. Liver cirrhosis in males causes similar endocrine changes. We carried out a post mortem study evaluating the prostates of 51 men who died with liver cirrhosis compared with a similar group without any hepatic disease. The occurrence of BPH in cirrhotic subjects was diminished and delayed compared to total population. Furthermore in cirrhotic men BPH is more common as early nodular hyperplasia (early stage) or stromal hyperplasia (suggesting estrogenic prevalence), while in the general population stromal and epithelial hyperplasia (androgenic stimulation), were almost equally present.

Human myelogenous (Ph+) leukemia cell line: transplantation into athymic mice.

Chronic myelogenous leukemia (CML) cells from line K-562, containing the Philadelphia (Ph1) chromosome, were transplanted into nude mice and grew as solid vascularized tumors containing cells like those seen in the patient and in the cultures. Cells taken from the tumors were near triphoid and retained all human chromosome markers in culture.