[Erectile dysfunction: a missed opportunity?]. / Disfunzione erettile: un'occasione mancata?

The increasing of andrological valuation for erectile dysfunction (ED), happened in the last ten years, and induced chemical industries and sanitary system to supply correct answers from cultural, diagnostic and therapeutic views. All these events allowed the people to approach easily to uro-andrological valuations. This situation is perhaps a unique way to involve a great number of men in a wide uro-andrological screeening, that is useful, with a total patient and couple involvement, not only for a ED causes research, but also for incidental pathology screening (neoplastic or dismethabolic). Even if more expensive than a simplified diagnostic ED protocol (95% of the patients accept it, if there is a good counseling), this way of diagnostic valuation permit to hit the targets and to add permanently andrology to scientific specialty, as the science that studies the sexuality behaviour of the man and all its pathology.

[Transitional carcinoma of the bladder at the T1G3 stage: personal experience]. / Il carcinoma transizionale della vescica in stadio T1G3: esperienza personale.

The Bladder T.C.C. represents about 70% of urological malignancies. Superficial T.C.C. is generally treated with T.U.R. followed by endocavitary chemoprophylaxis (Mitomycin, Antraciclines etc.). Invasive tumors are cured by radical cystectomy and reconstructive lower urinary tract. T1G3 bladder cancer (involvement but no invasion of muscle layers) is a "border line" lesion and is not uniformely treated (some Authors choose a "conservative approach with T.U.R. and chemoprophylaxis, some others prefer an "aggressive" treatment with radical cystectomy and urinary diversion. Authors present their experience in the treatment of T1G3 (19 patients in 4 years with one year minimum follow-up) with a "conservative" approach (bladder T.U.R.) but "aggressive" post-operative treatement (immunotherapy with B.C.G. vaccine) and endoscopic reevaluation after ten weeks from the first observation. Prognostic factors are examined (number and dimension of the tumors, concomitant mild or severe dysplasia, positive or not citology) in order to extrapolate patients that will be at risk for develop an aggressive disease.

[Urinary diversion using a Maizels catheter (K.I.S.S.S.) in pyeloplasty]. / Derivazione urinaria mediante catetere di Maizels (K.I.S.S.S.) nelle giuntoplastiche.

The increasing interest and progress showed by the surgical treatment of the ureteropelvic junction obstruction, have evidenced some problems that have not completely solved. Problem in which there is division in opinion concerns the role of splinting with or without nephrostomy in pyeloplasty. A strong impulse for proximal urinary diversion after pyeloplasty derived from data provided by Caine and Hermann (1), who have demonstrated in cineradiographic studies that the normal ureteral peristalsis did not return for about 3 weeks after anastomosis. The authors, who use systematically urinary diversion in pyeloplasty, emphasize the usefulness of the Kidney Internal Stent Splint Set (K.I.S.S.S.). This device developed by Max Maizels, From Children's Memorial Hospital Chicago USA, is employed after pyeloplasty, when kidney drainage is mandatory for the success of the procedure. The set contains: sof-flex stent, 55 cm. long: closed segment 25 cm. long, with 12 cm. malleable tapered positioning stylet; "cut-out" segment 30 cm. long. Silicone retention disc with pull-tie; Luer-lock adapter; 10 Fr. polyvinylchloride connecting tube 30 cm long. Introduction with the malleable stylet is the same as a nephrostomy interoperatively placed. The closed portion of the stent is sutured with adsorbable suture to the renal capsule and is performed as a nephrostomy drainage catheter. The "cut-out" portion is advanced interoperatively into the ureter. The K.I.S.S.S. explains essentially a twofold function: first to defend the neo-anastomosis, secondly like a nephrostomy drainage.

[The anterior approach after Chute, Baron and Olsson in renal pathology: the authors' own experience]. / Abordaje anterior según Chute, Baron y Olsson en patología renal: experiencia personal.

The authors describe their experience of 79 operations using the Chevron anterior transperitoneal approach in the treatment of 71 renal tumors and 8 cases of renal trauma. This approach respects the physiology of the respiratory system, has a low morbidity and mortality, in the post-operative period the need for anesthesia is moderate and hospitalization is shorter. The authors underscore the following advantages of the Chute-Baron-Olsson technique: it is easy to perform and can be easily extended, dehiscence and laparoceles are uncommon (only 2 of 79 patients). Furthermore, the Chevron partial or total approach in tumors and renal trauma permits exposure of an excellent inframesocolic and supramesocolic field and perfect control of the important elements of the renal vasculature.

Nucleolar organizer regions: preliminary results of the clinical use of a new marker for prostatic carcinoma (40 cases).

It is a widely diffused opinion that moving backwards in time the moment of the diagnosis of cancer of prostate, so that the tumor is detected earlier than normal, means that the treatment would be more effective than the one adopted in the usual times of diagnosis. For this reason the earlier diagnosis of prostate cancer has become more and more a compulsory target of the modern urologist, at a time of booming of the third age, of increased lifetime expectancy, of significant elevation of prostate cancer rate and of the persistent uncertainty of the efficacy of available treatments. Theoretically the mortality rate of prostate cancer can be reduced by the prevention programs and by the improvements of treatment methods, but the 'earlier' diagnosis is certainly an easier and less expensive strategy to achieve the same objective. The authors have evaluated the argyrophilic-nucleolar organizer region (Ag-NOR) proteins on 40 cases of adenocarcinoma of prostate collected through a multicentric program in France and in Italy. The Ag-NOR have been stained with silver technique set up by Ploton and Derenzini while the quantitative index has been evaluated by a semiautomatic system partially commercially available, partially modified by the authors. The conclusions: (a) the Ag-NOR index is a simple and reproducible method; (b) the Ag-NOR staging system corresponds to Gleason's grading; (c) the Ag-NOR elevation is a reliable marker of increased cell proliferation and is detectable much earlier than the morphologic changes of Gleason's classification.

A new marker for early detection and indicator of progression of cancer of the bladder. Preliminary results with Ag-NOR index in 38 cases of superficial bladder cancer.

The multiform biology of superficial bladder tumors, both morphologically and evolutively, and the lack of reliable predictors of progression have led the authors to study the Ag-NOR proteins as a new marker of these tumors. It is well known that particularly the low-grade superficial tumors frequently relapse on the same histologic and proliferative module. Their potential of progression is probably present at the time of the first manifestation of the disease or it can show itself along the relapsing evolution with classic modifications translating the cellular dedifferentiation. The NOR index, set up by the authors, has several advantages: firstly, it corresponds to a functional value of normal and neoplastic cells; secondly, it can be used also with paraffin blocks. Another advantage is the semiautomatic lecture, reproducible also in the urinary cytology, mainly of low-grade tumors, reducing the number of false-negatives. The conclusion of the study of 38 cases of superficial bladder cancer has induced the authors to believe that an increased NOR index is a reliable 'marker' of their progression. Therefore, the authors suggest the use of the NOR activity for the surveillance of the urothelial disease and for a more logical therapeutic strategy.

[Ectopic adrenal cortex tissue in the spermatic cord: clinico-surgical implications]. / Tejido córticosuprarrenal ectópico en el cordón espermático: implicaciones clínico-quirúrgicas.

Ectopic corticoadrenal tissue is not a very uncommon finding during orchiopexy in children. The causes can be found in the period of organ development and gonadal migration (spermatic cord). From 1986 to 1990, we have performed 88 orchiopexy procedures in the Urology Service of "San Antonio Abad de Gallarate" Hospital. Only one case (1.13%) of juxta-funicular corticoadrenal ectopia has been observed. The aim of the present study is to determine the correct surgical approach to this incidental finding during surgery of the inguinal canal in pediatric patients.

[Anticholinergic treatment in the therapy of primary enuresis. Effectiveness of oxybutynin chloride in a controlled clinical study of 58 patients]. / II trattamento anticolinergico nella terapia della enuresi essenziale. Efficacia dell'ossibutinina cloruro in uno studio clinico controllato su 58 pazienti.

2 groups of enuretic children were respectively treated with anticholinergic drugs dicyclomine and oxybutynin chloride. The results of the trial clearly indicate oxybutynin as the most effective drug in the treatment of the disease.

The anti-inflammatory action of flurbiprofen suppositories in paediatric urology in comparison with co-trimoxazole.

Fifty male children, aged between 3 and 10 years, were treated for a 12-day period with either trimethoprim (80-160 mg) plus sulphamethoxazole (400-800 mg) daily (co-trimoxazole) or 50-125 mg/day flurbiprofen rectally. The patients had been treated surgically for criptorchidism. Flurbiprofen showed good effectivity in controlling post-operative inflammation in urology. It is concluded that antimicrobial agents such as cotrimoxazole, because of their potential risks of damage at the cell's level, should be used only in presence of a bacterial infection.

Metergoline and bromocriptine in the management of tumoral and idiopathic hyperprolactinemia.

59 patients affected by amenorrhea or anovulation, 37 of whom also with galactorrhea, and with hyperprolactinemia of unknown origin (idiopathic hyperprolactinemia, 24 patients) or due to a pituitary microadenoma (tumoral hyperprolactinemia, 35 patients) were treated with metergoline (4-12 mg/day) or with bromocriptine (2.5 to 10 mg/day) for 90 days. The effectiveness of the two treatments was assessed on clinical grounds and by evaluating at monthly intervals serum progesterone levels, during the presumed luteal phase, and serum prolactin levels. The success rate with the two drugs was superimposable in terms of disappearance of galactorrhea and return of menses, normalization of prolactin levels and induction of ovulation. Also the number of pregnancies obtained (7 with metergoline, 9 with bromocriptine) was similar. With both drugs, the majority of patients responded to the treatment within the first month.

Benserazide and nomifensine in the diagnosis of prolactin-secreting pituitary adenomas.

Benserazide, an inhibitor of dopa-decarboxylase, stimulates prolactin (Prl) release in normal women and in puerperae; nomifensine, a dopaminergic drug able to release dopamine and to inhibit its re-uptake at the post-synaptic level, inhibits Prl release in the same subjects. Similar modifications of Prl release are evident in selected cases of non-tumoral hyperprolactinaemia, while neither drug modifies Prl release in patients with a Prl-secreting pituitary adenoma, in patients with 'functional' hyperprolactinaemia and in patients with 'functional' hyperprolactinaemia and in patients with minor abnormalities of sellar tomography. Neither drug modified Prl release in patients with macro- or microadenomas; several patients in the remaining groups failed to respond to one or both tests, the concordance between the two tests averaging 75%. Patients responding to both tests, to one test or to neither test showed progressively higher basal Prl levels. Since benserazide and nomifensine can indicate the presence of a pituitary adenoma earlier than sellar tomography, our results indicate that patients with no Prl response to one or to both tests probably harbour a pituitary adenoma which cannot yet be revealed by sellar tomography.

A case of renal oncocytoma.

A case of renal oncocytoma angiographically diagnosed and successfully treated by in situ tumorectomy under local hypothermia is presented.