Uncommon complication of endoscopic ureterolithotripsy: the stone granuloma.

Endoscopic management of urolithiasis is one of the commonest urological procedures today. It is usually safe and effective but one of the possible complications is ureteral obstruction. Stone fragmentation after ballistic lithotripsy and ureteral wall perforation could explain the mechanism responsible for this occurrence. We report a case of stone granuloma, occurring after a ballistic ureterolithotripsy.

Detection of telomerase activity in prostate massage samples improves differentiating prostate cancer from benign prostatic hyperplasia.

PURPOSE: We performed a case-control study in which we tested the ability of a non-invasive assay to detect telomerase activity and to distinguish between prostatic cancer (Pca) and benign prostatic hyperplasia (BPH) on samples of epithelial cells obtained after prostatic massage. METHODS: Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay. We selected 60 patients with histologically proven Pca (30 cases) or BPH (30 cases). Specimens included in this study were from patients who had no suspicious findings on digital rectal examination for cancer, had clinical evidence of lower urinary tract symptoms, had no sonographic signs of Pca at the transrectal ultrasound evaluation, had total PSA values moderately elevated (2.6-15 ng/ml), and had no evidence of other urological cancers. The whole procedure was conducted in double blind between pathologists and molecular biology operators. RESULTS: Telomerase activity was detected in 90% of Pca cases and in 13% of BPH cases. The sensitivity (90%) and specificity (76%) of this method were calculated. The positive predictive value, negative predictive value, and diagnostic efficiency were 87%, 90%, and 88% respectively. CONCLUSION: Our data indicate that telomerase activity detected by TRAP assay on prostate epithelial cells collected by prostate massage can substantially improve the distinction between Pca and BPH conditions. One of the clinical benefits resulting from the use of this new assay would be to refine the biopsy indication and to avoid for several patients without Pca the unnecessary cost and the complications of prostate biopsy.

In vitro study of Human Dermal Fibroblasts seeded on two kinds of surgical meshes: monofilamented Polypropylene and multifilamented Polyestere.

Many different synthetic biomaterials have been recently proposed in the majority of the techniques for hernioplasty and pelvic floor surgery. Required qualities of an implantable prosthetic material have been well established in the past and today the biomaterials better performing to this purpose are the monofilamented Polypropylene (Marlex) and the multifilamented Polyestere (Mersilene). But, in spite of a wide surgical use of these two kinds of meshes, many failures of these implantations are reported leading to removal of the prosthetic implanted material. If some of these failures are due to errors in surgical technique, others seem to be due to inadequacy of the selected material, too much soft or too much stiff, or too much or too little incorporated into the host tissue. This experiment investigated the different behaviour of in vitro cultured Human Dermal Fibroblasts, seeded on specimens of both meshes and then observed by Light (LM) and Scanning Electron Microscopy (SEM). Around the multifilamented threads of Polyestere mesh, fibroblasts could grow very well, filling the holes and making a continous cell layer completely envelopping the mesh. At the same culture time, around the Polypropylene mesh only big groups of fibroblasts were evident at the thread interlacing points. Therefore, it could be concluded that both meshes stimulate good fibroblast attachment and proliferation but in a very different way and amount; it will be up to the surgeon to select the appropriate mesh according to the specific surgical purpose.

[Percutaneous treatment of varicocele: considerations and our experience]. / Trattamento percutaneo del varicocele: considerazioni e nostra esperienza.

UNLABELLED: Due to its high incidence and its affecting male infertility, varicocele is an important disease. Consequently, it is essential to choose the best treatment. MATERIALS AND METHODS: Since 1999 to 2000, 75 patients affected by varicocele (mean age 25 years) underwent percutaneous retrograde sclerotherapy through a right transfemoral approach. Pre-operative tests included physical examination, sperm analysis and colour Doppler sonography. According to Dubin and Amelar classification, 59% of patients were affected by Grade 3 varicocele. According to Hirsh classification, grade III-IV varicocele was diagnosed with colour Doppler sonography in 77.3% of patients. Mean operative time was 30 minutes with only 5 minutes of exposure to radiation. All patients were followed-up with colour Doppler ultrasound and sperm analysis 1, 4 and 12 months after the treatment. RESULTS: In 6 of 75 patients (8%) sclerotherapy was unsuccessful because it was not possible to catheterize the spermatic vein. No significant complications were observed pre and post-operatively. 3 patients complained of mild testicular pain and 1 case had a transient hydrocele. The patients were dismissed during the next 24 hours after the procedure. During follow-up, physical examination was unremarkable in all patients, while occlusion of spermatic veins showed by Doppler ultrasound at 4 and 12 months was achieved in 94% of patients. CONCLUSIONS: Retrograde sclerotherapy through trans-femoral approach is a safe and effective treatment. In our opinion it should be considered as the treatment of choice, especially if we consider the costs, hospitalization and complications of conventional surgery and laparoscopy.

[Ultrasonographic assessment of bladder volume]. / Valutazione ecografica del volume vescicale.

INTRODUCTION: The aim of this study is to evaluate intra and inter-observatory variability in the sonography measurement of bladder volume. MATERIALS AND METHODS: We have evaluated 138 patients (128 men and 10 women) affected by lower urinary tract symptoms with a mean age of 64 years (range 36-75) between December 2000 and June 2001. Sonography measurement of bladder volume was obtained at the end of a pressure/flow study with the double lumen catheter in situ. Measurement of bladder volume was performed by the same operator in 113 patients by calculating the transverse, longitudinal and anterior-posterior diameter; each measurement was repeated three times. In the remaining 25 patients examination was performed by three different operators for every patients, with a single evaluation for each operator. The real volume was measured by emptying the bladder using the urethral catheter. RESULTS: The real bladder volume in the intra and inter-observatory group was 240 +/- 130 and 145 +/- 97, respectively. First, second and third measurement in the intra-observatory group were 229 +/- 113, 231 +/- 112, 234 +/- 127, respectively. On the other hand, first, second and third measurement in the inter-observatory group were 131 +/- 73, 129 +/- 66, 143 +/- 94, respectively. CONCLUSIONS: Looking at our results, it is clear that there is no significant difference between every single measurement in the intra and inter-observatory group. In addition, the estimation of bladder volume by ultrasound was quite similar to the real volume. We conclude that ultrasound is a precise, non invasive and highly reproducible technique to calculate the bladder volume.