Ischemia of the glans penis following circumcision: case report and revision of the literature.

Ischemic complications of the glans penis are rare and commonly result from trauma, inadvertent administration of vasoconstrictive solutions, diabetes mellitus, circumcision and vasculitis; we refer about a young man with severe ischemia of the glans penis following circumcision. The patient had undergone circumcision 5 days before in a surgery department under local anesthesia (1% mepivacaine hydrochloride). The patient noticed a brownish color and edema of the glans penis at 24 h after he opened the wound dressing, but arrived to our hospital only 5 days after circumcision because these findings had progressed. Physical examination revealed the black color or necrotic appearance of the glans penis, and edema on the dorsal penile skin. The patient underwent antibiotic, antiplatatelet, corticosteroid and iperbaric therapy achieving a complete restitutio ad integrum.

Acute Scrotum Following Traumatic Spermatic Cord Hematoma: A Case Report and Review.

Acute scrotum constitutes the most common urological emergency secondary to spermatic cord torsion, testicular trauma, orchiepididymitis and hernias. We report a very rare case of unique traumatic spermatic cord hematoma following scrotum injury occurred during a football match. Clinical exam showed an increased volume of the left spermatic cord; the color Doppler ultrasound (CDU) demonstrated left testicular ischemia secondary to a large spermatic cord hematoma that needs surgical exploration. Spermatic cord hematoma rarely induces acute scrotum, however it could be treated conservatively surgery is mandatory when pain is persistent or testicular ischemia is confirmed by CDU.

Erectile function after repeat saturation prostate biopsy: our experience in 100 patients.

INTRODUCTION: Erectile dysfunction (ED) incidence following repeat saturation prostate biopsy (SPBx) was evaluated. MATERIALS AND METHODS: From January 2011 to June 2012 295 patients underwent repeat transperineal SPBx (median 28 cores) under sedation. The indications for biopsy were: abnormal DRE, PSA > 10 ng/mL or included between 4.1-10 with free/total PSA < 25%. All patients were prospectively evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5) at baseline and 1, 3 and 6 months from SPBx. RESULTS: 100/200 men with benign histology and normal sexual activity completed the study; median IIEF-5 score before and after SPBx was equal to 18.3 (baseline) vs 17.8 (1 month later) vs 18 (3 months later) vs 18.1 (6 months later) (p > 0.05); in detail, 1 month from biopsy 5 (5%) men referred a mild ED that disappeared at 3 and 6 months evaluation. CONCLUSIONS: Repeat transperineal SPBx under sedation did not significantly worsened erectile function; the minimal risk of temporary post-biopsy ED could be previously discussed (not emphasised) with potent patients.

Does prolonged anti-inflammatory therapy reduce number of unnecessary repeat saturation prostate biopsy?

INTRODUCTION: The effect of a prolonged oral anti-inflammatory therapy on PSA values in patients with persistent abnormal PSA values after negative prostate biopsy (PBx) was evaluated. MATERIAL AND METHODS: From September 2011 to September 2012, 70 patients (medi- an age 62 years), with persistent abnormal PSA values after negative extended PBx, were given an herbal extract with anti-inflammatory activity for 3 months (Lenidase®; 1 tablet daily constituted of baicalina, bromelina and escina). All patients were submitted to prostate biopsy for: abnormal DRE; PSA > 10 ng/mL, PSA values between 4.1-10 or 2.6-4 ng/mL with free/total PSA < 25% and < 20%, respectively. Three months after the end of anti-inflammato- ry therapy all patients were revaluated; indication for repeat saturation biopsy (SPBx) and detection rate for PCa were compared with those previously recorded in our Department using the same inclusions criteria for biopsy. RESULTS: Oral administration of Lenidase® was well tolerated and no side effects were observed; PSA values decreased in 54 (77.8%) out 70 patients with a median PSA reduction of 20.5% (from 8.8 to 7 ng/mL) and remained unchanged in 16 patients (22.2%); the repeat SPBx rate resulted significantly lower (22.8% vs 35.5%; p < 0.05) showing a superimposable detection rate for PCa (3 cases) in comparison with our previous data (18.7% vs 22%). CONCLUSIONS: In our preliminary data a prolonged oral anti-inflammatory therapy reduced PSA levels in patients with negative PBx and persistent suspicious for PCa decreasing the indication to perform repeat SPBx (about 30% of the cases).

Prostate cancer detection at repeat biopsy: can pelvic phased-array multiparametric MRI replace saturation biopsy?

AIM: Magnetic resonance imaging (MRI) accuracy in prostate cancer (PCa) diagnosis in men submitted to saturation prostate biopsy (SPBx) was evaluated. MATERIALS AND METHODS: From June 2011 to December 2012, 78 patients (median 63 years) underwent repeat SPBx (median 28 cores). Multiparametric MRI using a 3 Tesla pelvic phased-array coil was performed before SPBx and lesions suspicious for PCa were submitted to additional targeted biopsies. RESULTS: A T1c PCa was found in 32 (41%) cases. SPBx vs. MRI-suspicious targeted biopsy diagnosed 28 (87.5%) vs. 26 (81.2%) PCa missing four (12.5%) and six (18.8%) cancers localized in the anterior zone and in the lateral margin of the prostate, respectively; moreover, MRI diameter lesions correlated with PCa diagnosis and Gleason score (p<0.05). CONCLUSION: Multiparametric MRI improved SPBx accuracy in diagnosing PCa of the anterior zone; moreover, suspicious areas >10 mm resulted as highly predictive of cancer (about 70% of the cases).

Prostate cancer detection after one or more negative extended needle biopsy: results of a multicenter case-findings protocol.

OBJECTIVES: To evaluate PCa incidence in patients with one or more negative extended prostate biopsy who underwent repeat biopsy or TURP. MATERIAL AND METHODS: From June 2003 to February 2008, 308 patients were submitted to repeat prostate biopsy (median 20.5 cores) and 120 patients underwent TURP after one or more 12 cores prostate biopsy. Indications for biopsy were: abnormal DRE; PSA > 10 ng/mL; PSA included between 4.1-10 or 2.6-4 ng/mL with free/total PSA < or = 25% and < or = 20%, respectively 262 and 46 underwent a second and a third biopsy: 218 because for high levels of PSA, 40 and 50 patients for a previous diagnosis of HGPIN and ASAP, 28 had an abnormal DRE. PSA in patients who underwent TURP was 11.6 ng/mL (median); in all cases DRE was negative and only 76 patients referred LUTS. RESULTS: PCa incidence at repeat biopsy was 16.9%; 96.2% of cancers were diagnosed at a second biopsy and 3.8% at a third one. PCa incidence was higher in patients with previous ASAP (43.4% and 50%) vs patients with HGPIN (25% and 0%) or benign pathology (11.9% and 0%). PCa was diagnosed in 11.1% and 19% of patients who underwent TURP previously submitted to a first and a second biopsy, respectively. CONCLUSIONS: In case of persistent suspicion of PCa after a repeated negative saturation biopsy, TURP should be proposed as part of the diagnostic procedure aside from LUTS, especially in patients with a life expectancy greater than 10 years.

Tissue-resonance interaction method for the noninvasive diagnosis of prostate cancer: analysis of a multicentre clinical evaluation.

OBJECTIVE: To determine, in a multicentre prospective study, the accuracy of the tissue-resonance interaction method (TRIMprob, new technology developed for the noninvasive analysis of electromagnetic anisotropy in biological tissues) in the diagnosis of prostate cancer. PATIENTS AND METHODS: Two hundred patients (mean age 67.4 years) scheduled to have prostatic biopsies (because of a prostate-specific, PSA, antigen level of >/=4 ng/mL or a suspicious digital rectal examination, DRE) were preliminarily examined while unaware of their clinical details using TRIMprob in five different centres. The final diagnosis obtained with TRIMprob was compared with the final histological diagnosis after extended biopsies. RESULTS: Of the 188 evaluable patients (mean PSA level 9.3 ng/mL, sd 8.8; mean prostate volume 62.0 mL, sd 32.4), 61 (32.4%) had a positive biopsy for adenocarcinoma of the prostate. The overall sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy of TRIMprob were 80%, 51%, 44%, 84% and 60%, respectively. The prostate cancer detection rate after biopsy was significantly higher in patients with a positive examination (49/111, 44%) than in patients with a negative TRIMprob (12/77, 15%; P < 0.001). When TRIMprob results were combined with DRE findings the sensitivity and NPV both increased to 92%. CONCLUSION: TRIMprob seems to be a useful tool in the diagnosis of prostate cancer and can increase the accuracy of PSA or DRE results. The high NPV suggests that this new technology might be useful to reduce the indications for prostatic biopsy or repeated series of biopsies in patients suspected of having prostate cancer.

Is free/total PSA predictive of pathological stage and Gleason score in patients with prostate cancer and serum PSA

INTRODUCTION: To evaluate whether percent free prostate-specific antigen (%-fPSA) could be predictive of pathological stage and Gleason score in patients with prostate cancer (PCa) and serum PSA of 10 ng/ml or less. MATERIALS AND METHODS: In 100 patients with total PSA7 were compared. RESULTS: 32 patients had an organ-confined and 68 a locally advanced PCa. Median %-fPSA level was 15%; Gleasonscore was <7 in 49 patients, equal to 7 in 40 and >7 in 11. Median %-fPSA levels in PCa with Gleason score7 was 14, 15.5 and 15%, respectively. Multiple logistic regression analysis did not show any correlation between %-fPSA in organ-confined vs. non-organ-confined PCa (p=0.4991) either between Gleason score<7 vs. equal to 7 (p=0.588) or >7 (p=0.547). CONCLUSIONS: %-fPSA cut-off does not seem to be useful for preoperative staging of patients with PCa and serum PSA

Straightening corporoplasty for Peyronie's disease: a review of 218 patients with median follow-up of 89 months.

OBJECTIVE: To evaluate the outcome at long term follow-up after straightening corporoplasty of penile curvature due to Peyronie's disease. METHODS: Between 1986 and 2001 a total of 279 patients with Peyronie's disease were operated on using the Nesbit procedure. We were able to obtain complete follow-up data in 218 patients. The follow-up data included evaluation of complete correction of the curvature, penile shortening, sexual function, complications and subjective patient satisfaction. RESULTS: After a median follow-up of 89 months subjective patient determination of satisfaction indicated that 83.5% were completely satisfied with the results of surgery. Complete correction of the penis was obtained in 86.3% of the patients. One hundred and ninety patients (87.1%) had good erectile function (IIEF-5 >21). Shortening of the penis (from 1.5 to more than 3 cm) occurred in 38 patients (17.4%), but only in 5 (2.3%) was intercourse difficult because of excessive shortening. Major sensory changes, confined to the glans area, were reported by 24 patients (11%). CONCLUSION: The Nesbit operation is a simple and safe technique to correct the penile deformity due to Peyronie's disease. This technique results in the greatest amount of patient satisfaction about erectile function. The procedure can be used to correct all degrees of penile curvature successfully except for the short penis. Informed consent should be amply discussed before operating in regard to the risk of penile shortening and major sensory changes of the glans area.

Sexual function after highly selective embolization of cavernous artery in patients with high flow priapism: long-term followup.

PURPOSE: We present 15 cases of high flow priapism treated by selective embolization and evaluate erectile function at long-term followup. MATERIALS AND METHODS: Between 1995 and 2001, 15 patients underwent highly selective embolization of the cavernous artery for high flow priapism. Trauma was reported by 12 of the 15 patients, and no etiologic causes were evident in the other 3. The fistula was unilateral in 13 patients and bilateral in 2. All patients underwent embolization during arteriography. Erectile function was determined using the International Index of Erectile Function (IIEF) at followup after an average of 55 months (range 18 to 93). RESULTS: Postoperative color Doppler ultrasonography showed no recurrence in 11 patients (73%). Repeat pelvic angiography with selective embolization was required at 1 month postoperatively in 3 patients (20%). In 1 case (7%) 3 consecutive embolizations were not conclusive and a surgical operation was required. The IIEF results showed that sexual function was in the normal range in 80% of patients. Three patients (20%) reported a slight change in the quality of erection. Mean postoperative IIEF score was 26.3 (range 18 to 30). CONCLUSIONS: Highly selective embolization of the fistula is an effective and safe treatment option for high flow priapism because it ensures a high level of preservation of pretreatment erectile function.