[Continence problems after radical prostatectomy: role of rehabilitation of the pelvic floor]. / Problemi di continenza dopo prostatectomia radicale: ruolo della rieducazione del piano perineale.

Continence mechanisms can be compromised after radical prostatectomy. Relatively low percentages of urinary incontinence are reported (2-15%). Perineal floor physiotherapy is considered an actual method of treatment of urinary incontinence in females. It is based on pelvic floor muscles exercises, biofeedback and functional electrical stimulation. The aim of physiotherapy is to improve pelvic floor muscles proprioception, to increase tone of levator ani and to favour automatization of these muscles in daily life. The reports in Literature on perineal floor physiotherapy in treating incontinence after radical prostatectomy are scarce. In this paper we present our experience about 9 patients with incontinence post radical prostatectomy (out of 74 patients operated on at our Institution). We obtained an improvement or a complete cure in 78% of the treated patients. We believed that pelvic floor physiotherapy can be considered a good and safe method of treatment of incontinence after radical prostatectomy, at least in less serious cases.

[Symptoms of prostatic hypertrophy: evaluation parameters]. / Sintomi dell'ipertrofia prostatica: parametri di valutazione.

To evaluate BPH symptoms many questionnaires have been proposed. The World Health Organisation Consultation on BPH recommended the "AUA-7 questionnaire" to which and additional on the quality of life was added, creating the "International Prostate Symptom score" (I-PSS). In any case, before proposing a surgical therapy, you have to correlate between symptoms, gland size and urodynamics. The only method to accurately evaluate outflow obstruction is pressure/flow study.

[New methods for the evaluation of cervico-prostatic obstruction]. / Nuovi metodi di valutazione dell'ostruzione cervico-prostatica.

To study outflow obstructions Schafer (1989) has recently proposed a simplified method based on a graph derived from over 1000 pre and post-op. P/F studies. 42 patients with BPH were evaluated according to this method. 11 patients had no outlet obstruction (26%). Surprisingly, only 15 had a normal detrusor, while 27 had a weak detrusor. The second part of the study concerns 24 patients with post-prostatectomy frequency-dysuria syndrome. Only 21% of these patients showed an outlet obstruction; while 58% showed a weak detrusor as responsible for their symptoms.

Nerve conduction velocity of dorsal nerve of penis: a modified technique.

The dorsal nerve of the penis is involved in sexual function. Until now, the nerve conduction velocity (NCV) of the dorsal nerve of the penis has been measured by dividing the distance between the stimulating and the recording electrodes by the latency to the negative peak of the action potential. With the penis stretched with a 1 lb weight, the NCV in normal men was 33 m/sec +/- 3.8. Measuring the NCV in this way, we became aware that when we decreased the distance between the stimulating and the recording electrodes, the velocity decreased. Furthermore these different measurements were linearly related. Taking this into account, we calculated the NCV with mathematical formula. In normal people, it turned out to be faster than reported previously.

[Renal adenocarcinoma: 20 years of surgical experience, 1970-1990]. / Adenocarcinoma renale: un ventennio d'esperienza chirurgica 1970-1990.

Epidemiology, diagnostics, staging, surgical procedure and survival data of 219 patients with renal cells carcinoma are reported (1970-1990). Diagnosis is based on Tc and angiography. Possibly in the future high sensitivity methods like Magnetic Resonance could limit the use of invasive techniques. 207 patients underwent radical nephrectomy and 68 of these lymphadenectomy too (para and pre aortic and/or caval). In 41 patients the tumor had involved the venous system and 9 cavatomies, 2 caval resections and 1 atriotomy have been performed. In the stage T1-T2-T3 NoMoVo the survival rate (at. 5 years) is 87%, 80%, and 75% respectively. The survival in N+MoVo patients is 17% (at 5 y.) and in V+NoMo patients 57%.

Effectiveness mechanism of chlomipramine by neurophysiological tests in subjects with true premature ejaculation.

The effectiveness mechanism of the chlomipramine treatment was evaluated by sacral evoked response (SER) and dorsal nerve somatosensory cortical evoked potential (DN-SEP) testings in 15 patients with true premature ejaculation (TPE). We couldn't demonstrate any significant difference between the values of either latency times or amplitudes of the evoked responses determined just before and at the end of the treatment with chlomipramine in these patients. However, the sensory thresholds were 24.4 +/- 4.3 V in the pretreatment term and 30.2 +/- 7.3 V at the end of the treatment. This difference is statistically significant (P = 0.0031). Our results suggest that chlomipramine increases the sensory threshold for the stimuli in the genital area.

Clinical, urodynamic and neurophysiological findings in patients with neuropathic bladder due to a lumbar intervertebral disc protrusion.

UNLABELLED: Sacral nerve roots are affected in 1 to 15% of reported cases of lumbar disc protrusions (mainly posterior) (Scott, 1965). Urinary retention is the commonest symptom. In the last 6 years, we have observed 22 patients (18 males and 4 females) with a neuropathic bladder due to this condition in the acute phase. They underwent intermittent catheterisation (IC), and manoeuvres such as Credé and Valsalva's at fixed times. Almost all obtained a balanced bladder. ( FOLLOW-UP: 24 months.) The most common urodynamic finding at the onset was bladder areflexia with severe denervation of the perineal floor. At follow-up, 65% still had bladder areflexia and 29% normoreflexia, all with normal compliance. Perineal floor innervation showed a fair recovery, mainly in the efferent part. An hypothesis is presented to explain why this kind of neuropathic bladder has a normal compliance.

Cortical evoked potentials in subjects with true premature ejaculation.

Cortical somato-sensory evoked potentials (SEPs) from pudendal stimulation were determined in 23 patients with true premature ejaculation (TPE) and in 25 subjects as a control group. SEPs give a cortical representation of the sensory stimuli arising from the genital area. The amplitudes of the evoked response in the cortical area (P1-N1-P2 wave) were 4.96 +/- 1.89 microV in subjects with TPE and 3.79 - 1.38 microV in the controls (means +/- SD). This difference is statistically significative (P less than 0.005). Our results show a greater cortical representation of the sensory stimuli from the genital area and suggest an organic basis for TPE.

The neuropathic bladder in children with spinal cord injury.

The occurrence of spinal cord lesions in children has been reported to be rare. In the literature, there is little information about the management of the neurovesical dysfunction. We report our experience in the treatment of the neuropathic bladder in 18 children with spinal cord injury. The long-term follow-up shows that there is a good recovery and the complication rate is low.

Penile arterial Doppler evaluation in basal condition and after intracavernous injection of papaverine.

In diagnostic screening, 73 impotent patients were submitted to a Doppler study of the deep penile arteries under basal conditions and after oral nitroglycerin (Basal-DOPPLER) and after intracavernosal injection of 30 mg of papaverine (ICIP-DOPPLER), as well as other tests. The results of the Basal-DOPPLER and the erectile response to intracavernosal administration of 30 mg papaverine (ICIP-30), indicative of the condition of the deep penile arteries, were in total agreement for 33 cases, partial agreement for 29 cases and totally in disagreement for 11 cases. The agreement between the results of the ICIP-DOPPLER and the ICIP-30 was total for 40 cases, partial for 24 and totally lacking for 9. In many of the cases for whom the response to ICIP-30 was less than would have been expected from the ICIP-DOPPLER, abnormal venous outflow was later shown. Our data support the hypothesis that papaverine acts on the venous component of erection. The ICIP-DOPPLER was found to be apparently more reliable than the Basal-DOPPLER for evaluating the arterial component of erection, but Basal-DOPPLER is still the basic screening test before any such invasive test as the ICIP are used, since these latter are not always accepted immediately by the patients.

Evoked sacral potentials in subjects with true premature ejaculation.

Evoked sacral potentials were used to study the bulbo-cavernous reflex in 85 patients with true premature ejaculation (TPE) and in 52 subjects as a control group. In the perineal and perianal recordings the amplitudes of the evoked responses (means +/- SD) were 70 +/- 91.1 microV and 35.6 +/- 36 microV in the TPE patients, and 39.2 +/- 36.8 microV and 26 +/- 21.6 microV in the controls, respectively. Both these differences resulted significant (P less than 0.01 and P congruent to 0.05, respectively). Our results suggest a reflex hyperexcitability, or an impaired "modulation" of the motor neurons of the pudendal nucleus by the regulating upper centers in the TPE patients.

Intracavernous injection of papaverine in paraplegic males.

Intracavernous injection of papaverine (ICIP) results in an improvement of erectile function in impotent patients. We have treated with ICIP 22 spinal cord injured men with erectile disturbances. 20-30 mg of papaverine were injected into one of the cavernous bodies and the quality and duration of erections were controlled. A complete penile rigidity was obtained in 20 patients; 7 cases presented prolonged erections (more than 300 min); 9 patients reported significantly improved erections in the days after the procedure. 10 patients accepted instruction in self-injection. After a training period a sufficient quantity of papaverine was dispensed for 1 month to each patient and one intercourse weekly was suggested. At the monthly visit the patient was asked about results of injection, frequency of coitus and liver function tests and general examinations were performed. Our self-injection program is still going on, until now we have had no dropouts and all the patients resumed coital penetration.

Effect of an alpha-blocking agent (phenoxybenzamine) in the management of premature ejaculation.

Phenoxybenzamine has been extremely effective in treating patients with vesical dysfunctions, its minimal side effects include anejaculation and delay and difficulty in ejaculation. Fifteen men were treated with phenoxybenzamine (PBZ) for premature ejaculation. Eight patients reported a subjective improvement of the time from penetration to ejaculation. PBZ is a well tolerated drug. The only side effect of the treatment was dry ejaculation. The Authors suggest its use in selected patients.