Effects of surgery, medical therapy and combined therapeutical approach on spermatogenesis in patients suffering from varicocele: a prospective and comparative analysis.

The definite mechanisms through which varicocele affects spermatogenesis are still not completely understood, and consequently the exact role of the various approaches available for its treatment is still under debate. In this study a comparison of medical treatment, surgery and combined approach is reported. MATERIAL AND METHODS. The study was conducted as a prospective evaluation of 189 patients suffering from varicocele and oligoasthenospermia. Patients were randomized in three groups on the basis of the different therapeutic approach: group A, treated only with varicocelectomy; group B, treated with varicocelectomy associated with hormonal therapy; group C, treated only with hormonal therapy. Randomization criteria were based on patient's preference. Spermiogram tests were carried out at baseline and after 3, 6 and 12 months from therapy. RESULTS. Our results show that patients undergoing a combined therapeutical approach (surgery associated with hormonal therapy) and medical therapy alone achieve a greater improvement of seminal parameters than patients treated by surgery only. CONCLUSION. Data reported in this study are in accordance with Literature review. Furthermore, the association between varicocelectomy and early use of hormonal therapy seems to improve testis functional rehabilitation with a early evidence of sperm parameters improvement. In the light of these results of ours, we should conclude that surgical treatment is not effective for the spermatogenesis improvement.

Enterovesical fistulas secondary to Crohn's disease:medical versus surgical therapies.

The purpose of this study is to evaluate the efficacy of medical therapies, especially infliximab, to induce remission of enteric fistulas in Crohn's disease (CD). Similarly to CD, chronic transmural inflammation of the bowel, diverticulitis and other pathologies may predispose to the development of fistulas. The risk of fistulization secondary to CD ranges from 17% to 80%. We focused on enterovesical fistulas, which statistically represent 10% of all fistulas secondary to CD. MATERIAL AND METHODS. In this study we decided to implement a therapeutic program with infliximab 5 mg/kg associated with steroids, which proved to be the most effective method of treatment. From January 2003 to March 2005, we studied 4 patients with CD and enterovesical fistulas. All patients underwent NMR, colonoscopy and cystoscopy combined with fistulography; a therapeutic strategy with cortisone, mesalazine, nutritional therapy and infliximab was established. RESULTS. No regression was observed; therefore, all the four patients underwent surgery with complete remission of symptoms. CONCLUSIONS. Data reported in literature and the evidence from our experience seem to be contradictory; we concluded therefore that it is mandatory to consider different therapeutic approaches, according to the fistulizing pathways, to such a complex disease, and to formulate some hypothesis that might explain why this treatment was unsuccessful in our patients.

Technical modification of Mainz pouch II urinary diversion: preliminary experience.

Use of the Mainz pouch II technique leads to a reduction in the complications frequently observed because of the high pressure associated with ureterosigmoidostomy. A technical variation of the procedure is described in which reimplantation of the left ureter in the rectosigmoid is carried out to avoid the risk of stretching and kinking and the need to fix the pouch to the sacrum. Furthermore, this procedure is easier to perform and less time consuming.

Percutaneous sclerotization of simple renal cysts with 95% ethanol followed by 24-48 h drainage with nephrostomy tube.

AIM OF THE STUDY: We propose some technique devices for treating simple renal cysts with percutaneous puncture (PCN) to reduce recurrences. MATERIALS AND METHODS: Between January 1995 and December 1998, a series of 42 patients, 13 females and 29 males, ranging in age between 49 and 73 were treated for symptomatic kidney cystic disease. The cysts varied between 7.4 and 13.6 cm in diameter and from 100 to 570 cm(3) in volume. This technique consists of echo-guided emptying of the cyst, and slowly inserting a quantity of pure 95% ethanol, equivalent to about 1/3 of the cyst volume, into the cavity. This acts as a sclerosant agent on the cyst walls. The protocol of this technique also includes positioning a curled drainage catheter, for 24-48 h, in suction, to ensure a correct collapse of the cyst walls and to avoid cyst recurrence. RESULTS: Of the 42 patients treated, only 4 did not complete the protocol. In 3 cases, the patients were not able to stand the procedure because of intense pain during cyst filling with alcohol. The other patient had intracystic hemorrhage. The results were evaluated by ultrasonography at 7 days post-operatively and then at 1, 3, 6, 9 and 12 months later. There was a further follow-up lasting from 12 to 36 months. Of 38 patients treated, 29 (76%) did not have any recurrence. 8 patients (21%) developed a small liquid layer of 3-4 cm, which did not enlarge in subsequent check-ups. We observed a recurrence, which spontaneously reduced in volume, only in 1 patient. CONCLUSIONS: This procedure was simple to apply in an out-patient setting and used low-cost materials which are easily obtained. Moreover, the results appear to confirm the validity of this technique.