The use of vesical irrigation system dual pump Endo FMS urology in the endoscopic therapy of benign prostatic hyperplasia.

OBJECTIVE: Transurethral resection of the prostate (TURP) remains the reference standard treatment in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The objective of this study was to determine whether vesical irrigation during TURP with the dual pump system Endo FMS Urology is more efficient than standard gravity irrigation. METHODS: A group of 30 patients who underwent TURP using the Endo FMS Urology was compared to a group of 30 patients treated with standard vesical irrigation. RESULTS: A 40% decrease of fluid irrigated, a 10% decrease of time for procedure and a 10% increase in the volume of the resected tissue was observed in patients treated with the Endo FMS Urology compared to controls treated with standard vesical irrigation.

Percutaneous therapy of low stage and grade urothelial neoplasia: long-term follow up.

Nephroureterectomy with the excision of the ipsilateral ureteral orifice and bladder cuff has been considered the standard treatment of the urinary upper transitional cell carcinoma. With the advent of sophisticated techniques for the endo-urologic management of many benign urologic diseases of the upper tract, there has been growing enthusiasm for the application of these same techniques in the management of upper tract TCC, which is also supported by recent advances in the development of small calibre telescopes with improved optics and the development of small calibre adjunctive instruments and laser fibers. A large number of cases published in the literature has confirmed the safety and efficacy of percutaneous treatment in selected patients with upper tract TCC of low grade and stage. Between 1997 and 2005 we treated 62 pts (37 pelvic transitional cell carcinoma and 25 ureteral). 4 pts (5 renal units: 4 T1G2 and 1 TaG1) underwent percutaneous resection for a tumor in a solitary kidney (2 cases), one case for bilateral neoplasm, and in the other case the lesion was unilateral with chronic renal failure. After preoperative evaluation, (excretory urography, computerized tomography and ureteroscopy with biopsy to confirm the low stage and grade of the lesion) the tumor was resected using an Amplatz sheat of 26-30 Fr and a 24 Fr resectoscope to keep a low intra-caliceal pressure. The tumor base was biopsied and fulgurated After 48 h, contrastography to assure integrity of the urinary system was performed and Mitomycin C was infused over 24 h. Second-look nephroscopy with multiple biopsies was performed in all cases 7 days later and 8 Ch nephrostomy was placed. If the biopsies resulted negative the patient was submitted to 6 weekly endocavitary instillation of BCG through the nephrostomy tube. All pts at a mean follow up of 71 months were tumor free. One patient presented a bladder relapse after 83 months. No complication of percutaneous resection was observed. The endocavitary instillations were well tolerated. In our experience the percutaneous approach is safe and useful in neoplastic lesions of low grade and stage and should be considered as first line therapy in selected patients. Adjuvant topical therapy appears efficacious and some complications may be avoided by maintaining low intracavitary pressures during administration.

[Extracorporeal shock wave lithotripsy as surgical therapy in the kidney-ureter calculosis]. / Extracorporeal shock wave lithotripsy as surgical therapy in the kidney-ureter calculosis.

INTRODUCTION: The coming of the extra-corporeal shock waves lithotripsy (ESWL) represented one of the main progress in medicine of all times. MATERIALS AND METHODS: From January '84 up to March '99, 7.508 patients underwent extracorporeal shock wave lithotripsy (ESWL) for renal, ureteral and bladder stones with a total of 13.032 treatments. 6.329 kidney stones, 2.165 ureteral-calculosis and 52 bladder stones, for a total amount of 8.546 stones were treated. Seven different lithotripters have been used: radiologic-based Dornier HM3 with electrohydraulic shock waves production, radiologic-based modified-Dornier HM3 with electrohydraulic shock waves production, ultrasonography-based Dornier MPL 9000 with electrohydraulic shock waves production, ultrasonography-based EDAP LT 01 with piezoelectric shock waves production, ultrasonography and radiologic-based EDAP LT 02 with piezoelectric shock waves production, ultrasonography-based Piezolith 2200 and the Piezolith 2300 only with piezoelectric shock waves production. In 1,451 patients an auxiliary action was necessary. RESULTS: Only a treatment was sufficient in 5.337 patients (77.7%), two in 1.497, three in 507 patients, four in 248 patients, five in 109, six in 55, seven in 34, eight in 9, nine in 12, ten in 5, eleven in a patient, twelve in a patient, thirteen in a patient, fourteen in two patients and fifteen in a patient. The patients who had a negative abdomen radiograph or ultrasound after two months were considered "stone-free". We have considered urolithies smaller than 3 mm as fragments, with the possibility of natural expulsion, non conditioning lying behind. Totally the results was: 5.950 patients "stone-free", 753 patients with fragments, 257 patients with non-broken calculi and 547 patients with dust only. The "stainstrasse" with spontaneous resolution and the one with instrumental resolution, the hyperpyrexia, the serious colics, the symptomatic renal haematomas and the intolerance to the treatment (vomiting and nausea) have been considered as complications. CONCLUSIONS: Nowadays, except for the cases in which are necessary admission to hospital and urgency treatment, since imminent colics are present, the ESWL may be performed in day-hospital. Since the first years of employment the ESWL has solved almost all the cases of urolithiasis. Nevertheless the experience has proved the extreme aggressiveness and inappropriate characteristics of a number sometimes too high of re-treatments. The ESWL should maintain the feature of non-spread methodic when it is possible to use it in cases solving with two--maximum three--treatments.

[Pathology and physiopathology of urethral stenosis]. / Anatomia patologica e fisiopatologia delle stenosi uretrali.

The research of new techniques for surgical repair of urethral stenosis, has developed interest and knowledge toward tissue handling and transfer in urology. Successful surgical repair of "long" stenosis is possible nowadays, using graft or flap tissue transfer. The knowledge of methral anatomy and of histopathology urethral anatomy, histopathology and physiopathology of the mechanism involved in process of urethral narrowing, is necessary for the diagnosis and the surgical indication of this pathology. To review physiopatological and anatomopathological aspects of urethral stenosis is the aim of the authors.