Morphological changes of bladder mucosa in patients who underwent instillation with combined sodium hyaluronic acid-chondroitin sulphate (Ialuril®).

OBJECTIVE: To investigate what changes are endoscopically evident after glycosaminoglycans (GAGs) therapy by hyaluronic acid (HA) and chondroitin sulphate (CS) (Ialuril®) in female patients affected by bladder pain syndrome(BPS)/ interstitial cystitis (IC) or recurrent urinary tract infections (rUTIs). PATIENTS AND METHODS: 21 female patients over 18 years affected by rUTIs or BPS/IC received intravesical instillation of HA and CS (4 weekly instillations followed by 2 instillations every 2 weeks and 2 instillation monthly). Post-treatment evaluation included cystoscopy and patient assessment of improvement in symptoms and satisfaction on a visual analogue scale (VAS) from 0 to 10. RESULTS: The post-treatment endoscopy showed a positive effect on bladder mucosa morphology. In 2 cases, treatment did not change endoscopic findings and clinical symptoms. In the other patients, when macroscopic features of the bladder mucosa normalized, the clinical picture improved. CONCLUSIONS: GAGs therapy by HA and CS (Ialuril) improves the morphology of bladder mucosa in patients with rUTI or BPS/IC.

Bladder papilloma in a 9-year-old girl: a case report.

Transitional cell carcinoma of the bladder is a rare entity in childhood. We report on a 9-year-old girl with transitional cell carcinoma of the bladder who presented with gross hematuria. Ultrasonography revealed a papillary lesion in the bladder, and the diagnosis was confirmed by cistoscopy. Complete transurethral resection of the lesion was performed and follow-up with urine cytology, vesical ultrasound and transurethral cystoscopy at 4 years showed no evidence of recurrence.

Videourodynamics in patients with neurogenic bladder due to multiple sclerosis: our experience.

PURPOSE: The aims of this study were to: (a) analyse the most frequent morphofunctional features of the lower urinary tract observed during videourodynamic examination in patients with neurogenic bladder due to multiple sclerosis; (b) investigate the role of the videourodynamic examination in the clinical management of these patients; and (c) demonstrate the relationship between morphological and functional variables. MATERIALS AND METHODS: We performed videourodynamic examinations in 75 patients affected by neurogenic bladder secondary to multiple sclerosis. RESULTS: The introduction of pharmacological therapy, based on clinical and functional evaluation of the lower urinary tract, is correlated with satisfactory morphofunctional outcomes, reducing moderate-to-severe postvoid residual (PVR; p < 0.1) and compliance (p < 0.05) at the price of reduced bladder sensation. Clinical management of these patients based on morphological evaluation of the lower urinary tract decreased the occurrence of detrusor-sphincter dyssynergy (DSD) and detrusor overactivity incontinence at the following examination. CONCLUSIONS: Our study confirmed a relationship between detrusor overactivity and hypertonic bladder, bladder diverticula, vesicoureteral reflux, between detrusor underactivity and PVR and between DSD and bladder diverticula. Our data show how the videourodynamic examination may improve evaluation and urological management of these patients.

Polypropilene sling of the bulbar urethra for post-radical prostatectomy incontinence.

OBJECTIVE: We present details of a modification of the Stamey procedure using a polypropilene mesh to compress the corpus spongiosum of the bulbar urethra in the treatment of sphincteric incompetence following radical prostatectomy. MATERIALS AND METHODS: Between September 1999 and June 2000 nine patients 66-80 years old (mean age 74) with severe incontinence due to radical prostatectomy underwent the bulbourethral sling procedure with polypropilene (Prolene) mesh implant. After transperineal incision a 5cmx4cm rectangular prolene mesh was placed against the bulbar urethra and suspended by four prolene sutures transferred to a suprapubic incision through ligature carriers as in the four corner bladder and bladder neck suspension. If leakage recurred in the follow-up, a retightening procedure was performed in local anesthesia rescuing the prolene threads over a polypropilene mesh placed against the rectus fascia. Mean follow-up was 14 months (range 12-20). Continence status and post-void residual volume were evaluated after 1, 3 and 6 months post-operatively and successively every 3 months. RESULTS: At the present follow-up considering the results of the retightening procedure five out of nine patients were cured, two out of nine improved and two were unchanged. Five out of nine patients reported slight to mild perineal/genital discomfort which disappeared in four at three months post-operatively. No patients required mesh removal for complications. CONCLUSIONS: The male bulbourethral sling procedure using a polypropilene mesh is safe but further experience is needed to establish this procedure as plausible alternative for the treatment of post-radical prostatectomy urinary incontinence.

Prions, prion diseases and decontamination.

Prions are extremely resistant to disinfection and sterilization methods used so far. The pathogenic prion protein core (called prion) consists of 142 amino-acids, is resistant to proteolytic enzymes, has a mass of 15 pikograms and is filtrable. Fixed by desiccation or chemicals may retain infectivity for years. It survives dry heat at 200 degrees C for 1-2 hours. Prions are fixed to stainless steel within minutes and remain infectious for long periods. Their pathogenetic properties depend on tertiary spatial structure (conformation) which is specific and transmissible in experiment. The prion decontamination appears by far the most important area of the prion science because very little, or nothing, has been done in the majority of world hospitals to prevent iatrogenic transmission. The number of potentially infectious patients is not known. Therefore, patients undergoing neurosurgery, laryngeal or ophthalmic operations, orthodental treatments and even anaesthetic or endoscopic applications should be classified into risk groups, even if clinically priondisease inapparent. The use (or misuse) of disposable instruments is certainly not the final answer for all cases and classic decontamination procedures, if possible because of the character of medical devices, appear still of greatest importance. We consider the high pathogen safety (HPS) autoclave from FEDEGARI as the best actual equipment for the effective decontamination of prions in the hospital practice. The investment costs are moderate and the handling is simple but must be careful. It appears practicable even in small specialized units.

[Four corner bladder base and bladder neck suspension with intraosseous anchorage in the treatment of moderate cystocele]. / La sospensione della base e del collo vescicale ai quattro angoli con ancoraggio intraosseo per la correzione del cistocele moderato.

During the last 10 years the original Pereyra technique of needle bladder neck suspension has been object of more than 36 modifications with the goal to improve long term results and to enhance feasibility. It represents also a part of the so called four corner bladder and bladder neck suspension (anterior suspending sutures) which is at present a reliable and durable manner to manage mild to moderate cystocele; this procedure reestablishes safely and simply support to bladder base, bladder neck and urethra preventing the onset of a denovo stress urinary incontinence. Complications include post-operative pain which could represent a problem in about 16% of the patients: it has been related to the entrapment of the ileoinguinal nerve between prolene sutures and rectus fascia and may be responsible of a delay in the re-establishment of a normal voiding pattern due to the pain elicited during any rectus muscle contraction. We propose a refinement of this procedure which includes the osseous anchoring of the suspending suture through the Mitek G II anchor system. Reduction in postoperative pain and fast recovery of a normal voiding pattern soon after surgery seems to be the most important result of this modification. Osteitis pubis has not been noted. Any improvement in long term durability of the procedure has not yet been determined due to the short follow-up and limited series of cases and the need for subsequent long term follow-up.

[Endoscopic treatment of vesico-renal reflux with teflon: personal experience among adults and neurologic patients]. / Correzione endoscopica del reflusso vescico-renale con pasta di teflon: esperienza personale nell'adulto e nel neuroleso.

Endoscopic injection of polytetrafluoroethilene (teflon) in the vesicorenal reflux correction was performed for the first time in 1981 by Matouschek. Since 1948 this method was widely employed in the clinical practices by O'Donnel and Puri. We present a review of our experience from march 1985 to february 1996 in 62 normal adult and 5 neurological patients (46 female and 21 male) with vesicorenal reflux and who were treated by means of endoscopic correction. In particular, in two patients who underwent radical cystectomy for bladder tumor, an anatomopathological study on the tissue, were teflon was previously injected, was performed. In this specimens no neoplastic area was found.

[Echo-color Doppler in acute scrotum]. / L'eco-color-Doppler nello scroto acuto.

The Authors report their experience about the use of color doppler US in the diagnosis of acute scrotal pain. Their data show the importance and the central role of color Doppler US to distinguish between phlogosis and ischemia.

[Echo-guided puncture of intraprostatic cysts: our experience]. / Puntura ecoguidata di cisti intraprostatiche: nostra esperienza.

Prostatic cysts are a pathological condition which is rare and still poorly known. In the past a precise diagnosis was difficult and was made with radiologic examination and/or cystoscopy and/or surgery. Up to date echotomography is the most important technique not only for the diagnosis but also for the treatment of prostatic cysts. The Authors relate upon their experience about diagnosis and treatment of prostatic cysts.

[Echographic localization and monitoring of bladder calculi treated with ESWL]. / Puntamento e monitoraggio ecografico di calcoli vescicali trattati con ESWL.

The standard treatments for bladder stones consist either of an open operation or endoscopic transurethral disintegration and extraction. These treatment require anesthesia and hospitalization. We report our experience of ESWL monotherapy in the treatment of 10 patients affected by bladder stones. Our early datas show that ESWL for bladder stones is a safe an effective therapy which can be performed without the use of anesthesia in an outpatient basis.

[Echography in the follow-up of patients receiving an endoscopic injection of teflon for vesico-renal reflux]. / L'ecografia nel follow up di pazienti sottoposti ad iniezione endoscopica di teflon per reflusso vescico-renale.

The surgical treatment of vesicorenal reflux implies open surgery and consequently an hospitalization. The sub-ureteric injection of poly-tetra-fluoro ethylene (Teflon) for correction of vesicorenal reflux was first utilized in 1981 by Matouschek. We have reviewed our personal experience with endoscopic correction of vesicorenal reflux from 1985 to 1990 and evaluated the importance of ultrasonography especially in the follow up.

[The Nissenkorn endourethral prosthesis: our experience]. / La protesi endouretrale di Nissenkorn: nostra esperienza.

The Authors report their experience about 40 patients who presented urinary retention by cervico-prostatic obstruction with anesthetic counterindications or limited life expectancy, cured with the urethral prosthesis of Nissenkorn (IUC). Our data permit to say that in selected patients IUC may represent an effective treatment with minimal invasiveness, low cost and few side effects.

Sensory disorders of the lower urinary tract: urodynamic evaluation.

Sensory disorders of the lower urinary tract (urethral syndrome, prostatodynia, painful pelvic-perineal syndromes, trigonitis) are clinically frequent, however this diagnosis is possible only by excluding other pathologies after clinical and instrumental evaluation. The Authors report their experience in urodynamic evaluation of sensory disorders of the lower urinary tract and they discuss about the absence of a typical urodynamic pattern of sensorial pathology.