Colposacropexy with Gore-tex mesh in marked vaginal and uterovaginal prolapse.

This study focusses on abdominal sacral colpopexy which appears to provide the most anatomically correct restoration and secure and durable support for advanced vaginal or uterovaginal prolapse. 21 patients underwent colposacropexy or hysterocolposacropexy using Gore-tex mesh. All patients referred symptoms of vaginal heaviness and urinary dysfunctions. Five presented with complete vaginal vault prolapse, 7 with third-degree anterior colpoceles and 9 with uterovaginal prolapse. Hydronephrosis was present in 4. Five patients had previously undergone total hysterectomy, and underwent only sacropexy; 9 underwent standard total abdominal hysterectomy before sacropexy; 7 underwent hysterocolposacropexy, preserving the uterus. In colposacropexy anchorage was designed to provide a large vagina-mesh contact area thus reducing the risk of suspension failure. Hysterocolposacropexy was performed using 3 stitches to anchor the synthetic mesh to the vagina and the uterine isthmus. Postoperative follow-up times range from 12 to 68 months. Overall results for 19/21 patients were satisfactory. In all 21 patients the descensus was markedly reduced. Hydronephrosis was completely resolved. Slight incontinence persisted in 3, but protection was not required. Slight dysuria persisted in 2. First-degree cystoceles recurred only in 3 patients who underwent hysterocolposacropexy. Sacropexy with synthetic mesh seems to be the most valid support of uterovaginal prolapse as the physiological vaginal axis is restored and vaginal function is preserved. Our success rate and the overall satisfaction expressed by 19/21 patients have encouraged us to continue in this surgical approach.

[Echographic study of the bladder neck and prostate region after Nd-Yag laser treatment]. / Studio ecografico del collo vescicale e della loggia prostatica dopo trattamento con Nd Yag Laser.

The authors describe the ultrasonic images they obtained in the follow up of three groups of patients who were divided according to basic pathology and treated with Nd: Yag Laser with contact (CLAP) and side firing (VLAP) fibers. Next the great differences noted between the results achieved with ultrasonic investigation and those obtained with flowmeter controls and IPSS are presented. The authors discuss the possible causes of these dissonances and hypothesize a new way to evaluate cervico-urethral de-obstruction: no longer an anatomical technique but a functional one.

Autologous adrenal medullary transplant in Parkinson's disease: critical review of our results in 13 patients.

Autotransplantation of the adrenal medullary to the caudate nucleus has been proposed for severe Parkinson's disease (PD). We describe our experience in 13 patients using a transperitoneal approach to the medullary and craniotomy for the implant: the neurosurgical equipe's decision to opt for craniotomy made quick removal of the medullary with minimal morbidity more difficult. The surgical technique are discussed. We evaluated also the impact of the procedure on urinary symptoms and sexual disturbances associated with PD. Results were disappointing. Four patients died post-operatively. The neurological pattern improved in three men and one woman. No significant improvement was observed in the urological and sexual dysfunctions.

Urethral syndrome: clinical results with antibiotics alone or combined with estrogen.

The urethral syndrome is very frequent in women but the etiology is unknown. In all 77 patients suffering from the syndrome, endoscopy revealed characteristic lesions in the trigonal area. As unidentified bacteria may be responsible, a microbiological investigation was carried out. Wide-spectrum or specific antibiotic therapy was prescribed as required. All patients were also randomized to 2 groups to assess the efficacy of local estrogen therapy. The authors concluded that wide-spectrum antibiotic therapy with macrolide and mepartricin should be the first choice of treatment and that local administration of estrogen does not significantly enhance the benefits achieved through antibiotic therapy. A detailed microbiological investigation is necessary when symptoms persist. Overall a positive result was obtained in 75.32% of the cases (58 patients). The presence of Streptococci negatively influenced the results of specific antibiotic therapy.

Urinary retention due to prostatic involvement in testicular lymphoma: a case report.

Testicular involvement was the first manifestation of malignant lymphoma in the present case; after six months the disease became generalized but repeated chemotherapy achieved amelioration with negative bone-marrow biopsy after one year. Then urinary retention appeared, due to prostatic involvement from primary testicular lymphocytic lymphoma. We believe that this is the first reported case of primary malignant lymphoma of the testicle with secondary localization to the prostate and acute urinary retention.

[Traumatic injuries of the urethra: an echographic study]. / Lesioni traumatiche dell'uretra: studio ecografico.

US in the lower urinary tract usually explores the bladder and the prostatic urethra. In this study we used US instead of x-rays to visualize the remaining urethra in 42 patients. US was useful in the presence of urethral trauma. The site and extent of injury, particularly peri-urethral lesions (hematomas, urinary collection and abscesses in relation to the urethra) were observed. Ultrasound's efficacy and reproducibility were also useful in post-operative follow-ups.