Use of new nephrostomy catheter for treatment of renal neonatal candidiasis.

Systemic candidiasis with renal involvement is a rare but well-recognized complication during neonatal intensive care treatment. In addition to intravenous administration of amphotericin B, decompression of the renal pelvis and irrigation of the involved kidney with the same drug through a nephrostomy tube will provide a high concentration of antifungal agent with a flushing effect. This procedure is not always possible due to the small size of the neonatal kidneys. We have conceived a new percutaneous trocar nephrostomy which allows its application directly in an incubator without using X-rays during a single procedure. In 3 cases a bilateral percutaneous nephrostomy was performed directly in the incubator using a one-step ultrasonically guided maneuver under local anesthesia. The funguria was successfully eradicated in all cases. The availability of a nephrostomy trocar of small dimensions leads us to an improved renal approach in newborns.

Urodynamic evaluation of urinary incontinence following radical prostatectomy: our experience.

Thirty-four patients after retropubic radical prostatectomy, were evaluated with urodynamic studies. Patients were divided in three groups depending on the degree of urinary continence. A statistically significant difference was found between different groups for the mean functional profile length and maximal urethral closure pressure. Detrusor instability was detected in 11 patients with moderate incontinence and in 1 patient with severe incontinence. Neither differences of age, previous prostatic surgery, tumour extension, nor preservation of the neurovascular bundles had any significant influence on recovery of continence.

Recurrences and progression of superficial bladder cancer following long-term intravesical prophylactic therapy with mitomycin C: 48-month follow-up.

A total of 208 patients with superficial transitional-cell carcinoma of the bladder (STCC) after transurethral resection were treated with 30 mg intravesical instillations of mitomycin C (MMC) weekly for 8 weeks, followed by monthly maintenance doses for 12 months. All patients were controlled with a urinary cytological examination every 2 months and with cystoscopy every 3 months. Mean follow-up was 47.8 and 49.3 months in the prophylaxis and control groups, respectively. The incidence of tumor recurrences at the 12th and 48th months was 29 and 44%, respectively, in the MMC group and 45 and 58%, respectively, in the control group. Progression evaluated by grade and stage was significantly higher in the control group. These data indicate that MMC appears to be effective in the prophylaxis of STCC, but the possibility of long-term relapse suggests maintenance of a longer therapy.

Bladder instability and incontinence after radical prostatectomy.

Thirty-nine patients were evaluated after retropubic prostatectomy, by urodynamic studies. They were divided into three groups depending upon the degree of urinary continence. A statistically significant difference was found between different groups in mean functional profile length and maximal urethral closure pressure. Differences in age, previous prostatic surgery, tumour extension, or preservation of the neurobundles did not have any significant influence on recovery of continence.

Vacuum constriction device and topical minoxidil for management of impotence.

OBJECTIVE: We report our preliminary experience with a vacuum constriction device and topical minoxidil for the management of impotence. METHODS: We evaluated 18 patients, 8 with neurogenic and 10 with psychogenic impotence with a vacuum constriction device and topical minoxidil (1 ml 2% solution). RESULTS AND CONCLUSIONS: All patients responded to treatment but 100 cases refused home use because of psychological impact. Twelve patients did not need the application of the constrictive ring because of the erection facilitation effect of minoxidil. No side effects were observed. In our opinion the association of the vacuum constriction device with topical minoxidil might be useful in the treatment of impotence; however, several factors must be evaluated in selecting patients. Application of minoxidil before vacuum constriction device might be useful to reduce the time of device application, to increase the efficacy of the device and in some cases to avoid the use of the constrictive ring.

[Laser and ultrasonic therapy in simultaneous emission for the treatment of plastic penile induration]. / Laser e ultrasuoni terapia in emissione simultanea nel trattamento dell'induratio penis plastica (IPP).

Induratio penis plastica (IPP) or Peyronie's Disease is characterized by the presence of one or more fibrous patches in the tunica albuginea or intercavernous septum. IPP is a slowly evolving disease which may cause a bending of the penis as well as pain during erection. As an alternative to the numerous pharmacological therapies already existing, or in association with them, some kinds of physical treatments, such as ionophoresis, ultrasound therapy and laser therapy, have recently been used. In this study we have evaluated the effectiveness of physical therapy combined with laser and Ultrasounds in the treatment of IPP. Sixty-eight patients were randomly divided into three groups: the first group was treated with orgotein infiltrations, the second with laser and Ultrasounds and the third with an association of both treatments. On the basis of this study, we can affirm that the effectiveness of laser therapy associated with ultrasounds in treating painful symptomatology of IPP at its initial phase overlaps that of orgotein infiltrations. No measurable modifications were documented neither in patch dimensions nor in their echostructures and in no case remarkable modifications of the penile bending were evidenced. Therefore laser therapy associated with ultrasounds represents at the moment an efficacious alternative to medical treatment of IPP at the initial phase, as it does not present any kind of contraindications and it is surely better tolerated than any treatment with penile infiltrations.

Densitometric and biochemical alterations in bony tissue induced by ureterosigmoidostomy.

The mineral content of bone was measured in 134 male patients who underwent ureterosigmoidostomy within the past 18 years. Moreover, the principal humoral indices of bone metabolism, together with hematic pH and alkaline reserve (BE) values were evaluated. This study showed that after approximately 6 years from a ureterosigmoidostomy there was significant bone demineralization. These data, supported by a parallel increase of serum osteocalcin, show that ureterosigmoidostomy represents a risk factor for osteoporosis especially in those patients who already have below normal values of bone mineral density prior to surgery.

Use of fibrin sealant in the treatment of prostatic cutaneous fistula in a case of Pseudomonas prostatitis.

Authors report on a case of Pseudomonas prostatitis complicated with a prostatoperineal fistula in continuity with the urethra that has been successfully treated with human fibrin sealant (Tissucol).

[Role of color-Doppler in the assessment of erectile impotence: personal experience]. / Ruolo del color-Doppler nella valutazione dell'impotenza erettile: esperienza personale.

We present our experience with colour duplex sonography in the assessment of 38 impotent men, whose ten underwent radical prostatectomy, following intracavernous pharmacological stimulation with PGE1. All patients with a clinical good response following PGE1 injection had peak cavernosal artery velocities > 30 cm/sec. The remaining suboptimal responders who presented an elevated end-diastolic velocity (> 5 cm/sec) showed a venous leakage demonstrated with cavernosography. Colour duplex sonography is a valuable and non-invasive tool in the assessment of impotence and can provide valuable information in the diagnosis of vasculogenic erectile dysfunction.

Intravesical mitomycin C for the treatment of carcinoma in situ of the bladder: 36 months follow-up.

Mitomycin C (MMC) was given intravesically over a period of 36 months to 14 patients with transitional-cell carcinoma in situ of the bladder (CIS). Initial complete response was obtained in 10 patients. Of these patients, 5 presented recurrences; one in T2 at the 32nd month, one had a relapse of CIS with diffusion to the prostatic urethra at the 34th month: both patients underwent cystectomy. The remaining three patients presented Ta or T1 relapses and underwent endoscopic resection and a new instillation of MMC. The 4 patients who did not respond were treated with a new instillation of MMC:3 were unsuccessful and underwent cystectomy (one at the 9th month, one at the 12th month for progression to T2 and one at the 14th month for involvement of the prostatic urethra); the 4th patient responded to the treatment but at the 14th month had a relapse of CIS and he underwent cobalt-therapy. At the 36th month, 7 out of 13 patients were free from neoplasm. A neoplastic progression occurred in 3 patients: one out of the 9 patients who responded to the treatment and two out of the 4 who did not respond. Diffusion to the prostatic urethra was observed in 2 of the 13 patients; one patient responded to MMC and the other did not. Five patients underwent cystectomy: 3 for neoplastic progression and 2 for involvement of the prostatic urethra. MMC seems to be effective for the treatment of CIS of the urinary bladder and the absence of a response to chemotherapy must be considered an adverse prognostic factor for the neoplastic progression.

Treatment of bladder carcinoma in situ with mitomycin C: long-term follow-up.

Mitomycin C (MMC) was given intravesically to 14 patients with transitional-cell carcinoma in situ of the bladder (CIS) between 1985 and 1989. Of the 10 patients with complete response two presented progression during the follow-up: one of them in T2 at the 32nd month, and one had a relapse of CIS with diffusion to the prostatic urethra at the 34th month: both patients underwent cystectomy. One patient died of an unrelated cause. At the 48th month 5 out of 7 patients were free from neoplasm. Neoplastic recurrence occurred in 3 patients: one responded to a second endoscopic resection and instillation of MMC, two presented further recurrences. Two patients underwent cystectomy: one for neoplastic progression and one for involvement of the prostatic urethra. MMC seems to be effective in the treatment of CIS of the urinary bladder and the unresponsiveness to chemotherapy must be considered as an adverse prognostic factor for the progression of the neoplasm.

Cellular expression of lymphocyte function-associated antigen-1 and intercellular adhesion molecule-1 in normal kidney structures and in renal cancer. Possible significance in immune response and in the clinicopathological correlation.

In this study we investigated the presence of lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) on renal cell cancer in 16 patients who underwent nephrectomy. In all cases, normal renal tissues presented ICAM-1 on the parietal epithelial cells lining Bowman's capsule while neither the visceral epithelium nor the glomerular endothelium were stained. The epithelial proximal and distal tubular cells were stained poorly (5 +/- 3 positive tubular cross sections/mm2). No renal cells were stained by the monoclonal antibody for LFA-1. In contrast, in renal cancer tissue we found 6 cases, negative for ICAM-1 and the others positive with a mean number of positive tubular cross sections of 52 +/- 37/mm2. In 10 cases staining with LFA-1 antibody was negative, while for the other cases the mean number of positive tubular cross sections was 11 +/- 8/mm2. Our results suggest that the expression of ICAM-1 and LFA-1 on the surface of malignant cells may explain the unusual clinical aspects of renal cell carcinoma, its association with the immune system, and clarify certain aspects of immunotherapy.

Self-retaining intraurethral device for treatment of prostatic obstruction.

We report our experience about insertion of 32 self-retaining intraurethral device (IUC) in patients with prostatic obstruction. Follow-up ranged between 2 and 38 weeks. Success rate of IUC insertion was 93.7% and 46.6% of patients have IUC in place without complications during follow-up. IUC is easy and quick to introduce, it allows spontaneous voiding, full continence, sexual activity and routine life-style. It represents a useful alternative to indwelling catheter in patients at high risk or refusing surgery and it might be used in patients who are waiting for surgery or need long term catheterization.

Effects of ipriflavone administration on bone mass and metabolism in ovariectomized women.

The aim of the present study was to assess the effects of ipriflavone administration in the prevention of the rapid bone loss that follows ovariectomy in women. After 10-30 days from bilateral ovariectomy, patients received either the sole calcium supplementation (500 mg/day, n = 16) or ipriflavone (600 mg/day, n = 16) in addition to the same daily calcium supplement for 12 months. In calcium-treated subjects urinary hydroxyproline excretion, serum alkaline phosphatase and plasma bone Gla protein levels showed a substantial (p < 0.01) increase, while radial bone density significantly (p < 0.01) decreased 6 months after surgery. In ipriflavone treated group the patterns of biochemical markers indicated that ipriflavone can restrain the bone remodeling processes and radial bone density showed no significant modification during the 12 month study period. These results demonstrate that ipriflavone administration prevents the rapid bone loss that follows ovariectomy. Thus, ipriflavone can represent an attractive alternative for the prevention of osteoporosis in postmenopausal women who present contraindications to the estrogen replacement therapy.

[Local hyperthermia in the treatment of benign prostatic diseases]. / L'ipertermia locale nel trattamento delle malattie prostatiche benigne.

Local Prostatic Hyperthermia is a 8 year old procedure that has been used for treating benign prostatic hypertrophy, chronic non bacterial prostatitis and prostatic carcinoma. We treated 80 patients affected by benign prostatic diseases who referred to our Clinic from November 1990 to December 1991. 42 patients were affected by benign prostatic hypertrophy (7 of them with permanent bladder catheter) and 18 patients were affected by chronic non bacterial prostatitis. A 915 Mhz microwaves generator apparatus with endorectal probe and cooling circuit has been used. The criteria we used to include patients in treatment were the following: high operating risk, the refusing of the operation, a prostatic volume bigger than 180 cc and finally a rectum thick less than 10 mm. All patients underwent preliminary echographic, hematic , urodynamic and rectoscopic exams. A prostatic biopsy was taken at the beginning and at the end of the treatment. During every session, which lasted sixty minutes and was repeated twice a week, we applied a temperature of 42 C degrees in patients with benign prostatic hypertrophy, and a temperature of 41 C degree in those with chronic non bacterial prostatis. Patients were checked with the same echographic and urodynamic parameters three months, six months and 1 year after the treatment. Subjective and objective symptoms improved in 65% of cases, and we also noticed a 50% reduction of post-urination residue, with an increase of maximal urinary flux. We also noticed a decrease of the dysuria and nycturia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinico-morphological changes in ectropion after treatment with polydeoxyribonucleotide (PDRN)]. / Modificazioni clinico-morfologiche dell'ectropion dopo trattamento con polidesossiribonucleotide (PDRN).

Thirty patients in fertile age affected by ectropion were treated with Polydeoxyribonucleotide (PDRN) (*) vaginal suppositories for 24 days. No other local or general therapy was allowed. The following parameters were evaluated: local symptomatology, tolerability and compliance, vaginal cytology, colposcopic examination, bioptic sampling of affected area prior to and after treatment, and local immune response. The results show the efficacy of PDRN. In fact, after the treatment: reduction of subjective symptomatology with decrease of average score for each symptom; excellent or good tolerability and acceptability; reduced inflammation; increased iodine-dark areas; reestablishment of normal balance in T- and B-lymphocytic populations have been found.