Studio prospettico sull’efficacia e la tollerabilità di un integratore alimentare nei pazienti affetti da infertilità primaria con astenoteratozoospermia idiopatica

Objective The male factor in worldwide infertility incidence is 20-30%. Sperm has high energy requirement for maturation, capacitation and motility. Many factors affecting sperm quality act through decreasing energy and increasing reactive oxygen species (ROS) by causing mitochondrial dysfunction. Sperm is vulnerable to ROS causing sperm immobilization, impairment of acrosomal reaction, abnormal morphology, DNA fragmentation and cell death. Design To determine the effect of antioxidant supplementation containing L-carnitine, acetyl-L-carnitine, fructose, citric acid, selenium, coenzyme Q10, vitamin C, vitamin B12 and zinc on sperm quality in subjects with oligo- or astheno-teratozoospermia, with and without varicocele and history of difficulty conceiving. Materials and Methods This was a monocentric, randomized, DBPC with a total of 104 patients, 52 in the supplementation and 52 in the placebo arm, that were recruited in 6 months. The enrollment was divided in 52 patients with varicocele grade I-III and 52 patients without varicocele. The study evaluated the efficacy of 6 months of supplementation (2 sachet daily) versus placebo (2 sachet daily). Spermogram evaluation, according to the WHO guidelines, was done at the beginning of treatment (V1) and at the end of the 6 month treatment (V2). Results Sperm count (number x106/mL) in patients with varicocele was 39.3 +/- SD 16.8 in placebo group and 49.4 +/- 18.9 in supplementation group (percentage change 25.7% t=2.04 p<0.05 Student test); in patients without varicocele 47.5 +/- 7.9 in placebo group and 52.3 +/- 9.1 in supplementation group (percentage change 9.9% t=2.01 p<0.05). Total sperm motility in patients with varicocele was 33.9+/- 6.9 in placebo group and 38.3+/- 8.0 in supplementation group (percentage change 18.6% t=2.10 p<0.05); in patients without varicocele was 35.0 +/- 7.5 in placebo group and 39.9 +/- 8.0 in supplementation group (percentage change 13.8% t=2.19 p<0.05). Progressive sperm motility in patients with varicocele was 23.1 +/- SD 6.7 in placebo group and 27.4 +/- 7.9 in supplementation group (percentage change 18.6% t=2.10 p<0.05); in patients without varicocele was 25.1 +/- 7.0 in placebo group and 29.7 +/- 9.1 in supplementation group (percentage change 18.6% t=2.07 p<0.05). Conclusions In our study, at the end of the treatment we observed a marked increase in quality parameters of sperm such as count and in total and progressive motility especially in varicocele patients. The supplementation was safe and no adverse events were observed. On this basis it can be established that the use of carnitines and other functional substances can form part of an efficacious strategy to handle male infertility

Up-to-date on erectile dysfunction and treatment

Erection is a haemodynamic event that involves the central nervous system and local factors and is the recurrent or persistent inability to achieve and or maintain an erection to allow satisfactory intercourse. The ED is a disease of great social impact: it is estimated that in Italy, 11-13% of men, or about 3 million are affected in part by ED. Main risk factors are: age, education level, anxiety, reactive depression, diabetes, heart disease, high blood pressure; disorders (hepatic failure, chronic renal failure, obesity, dyslipidemia); hormonal disorders (hypogonadism, hyperprolactinemia, hypo/hyperthyroidism); neuropathies (Alzheimer’s disease, Parkinson’s disease, degenerative diseases); urologic surgery, colorectal and vascular. Regarding therapy first and most important form of treatment for a patient suffering from erectile dysfunction is to identify and possibly modify or remove all hazardous conditions for sexual health. First line treatments are selective inhibitors of 5-phosphodiesterase; second-line treatments essentially include intracavernous injection of vasoactive substances and third line treatments include revascularization of the penis and prostesis implants

MRI and Active Surveillance for Prostate Cancer

No abstract availabl

T1G3 high-risk NMIBC (non-muscle invasive bladder cancer): conservative treatment versus immediate cystectomy

Background The management of stage T1 poorly differentiated G3 bladder cancer invading the lamina propria continues to be debated. These tumours are associated with a high risk of recurrence and progression; concomitant carcinoma in situ and/or multifocality are negative prognostic factors. Choosing between a preserving approach such as transurethral resection of the bladder (TURB) followed by maintenance bacillus Calmette-Guerin (BCG) and an invasive approach like cystectomy is critical. Patients and methods Overall, 80 patients underwent TURB and RE-TURB followed by intra-vesical induction treatment with BCG plus maintenance (Group A) while 72 patients underwent immediate radical cystectomy with extended lymphadenectomy (Group B). Patients were divided into 3 subgroups: uni-focal tumours, multi-focal tumours and carcinoma in situ associated lesions. In Group A, time to first recurrence and time to progression were analysed. A comparison was made between Group A and Group B regarding progression-free survival, cancerspecific survival and overall survival with a median follow-up time of 8.3 years. Results As far as concerns Group A patients, 42 recurrences (52.5%) were reported in a median time of 10.4 months (range 3–26) and 25 progressions (31.2%) in a median time of 25 months (range 3–68). As far as concerns time to first recurrence and time to progression, both the Kaplan–Meier survival curves obtained are significant and P values are, respectively, 0.0263 and 0.0011. Comparing Groups A and B patients, 25 progressions (31.2%) in a median time of 25 months (range 3–68) and 18 progressions (25%) in a median time of 25.9 months (range 4–72), respectively, were recorded. Regarding overall survival, at 10 years, 24 deaths (42.5%) occurred in a median time of 55.4 months (range 12–94) in Group A and 42 deaths (58.3%) in a median time of 54.9 months (10–100) in Group B. Cancer-specific survival was evaluated in Group A with a total of 18 deaths (22.5%) in a median time of 47.5 months (range 16–78), and in Group B with a total of 16 deaths (22.2%) in a median time of 45.7 months (range 16–88). The progression-free survival Kaplan– Meier curve is not significant, the P value being 0.3801; the overall survival curve is significant with a P value of 0.0487 while the cancer-specific survival curve is not significant with a P value of 0.9762. Discussion In Group A, considering ‘‘time to first recurrence’’, the difference is greater between unifocal lesions and multifocal or Cis-associated lesions. Conversely, for ‘‘time to progression’’, there is a greater difference between unifocal and multifocal tumours and Cis-associated tumours. Looking at ‘‘progression-free survival’’ in Group A and Group B patients, there is no statistically significant difference, like in cancer-specific survival. A statistically significant difference was observed in overall survival being in favour of conservative treatment thus reflecting that conservative treatment is not burdened by all the surgical and post-operative complications of cystectomy. Conclusions Although NMIBC invading the lamina propria, stage G3, with or without Cis-associated lesions are burdened both by a high volume of recurrences and progressions, cystectomy could be considered an aggressive approach. New biological markers are now needed which are able to predict the behaviour of the cancer and to guide the decisionmaking process between conservative or aggressive treatment

Knotless "three-U-stitches" technique for urethrovesical anastomosis during laparoscopic radical prostatectomy

We describe a new technique for urethrovesical anastomosis that consists of placing three “U” stitches of Monocryl 2-0 to connect the bladder neck and urethral stump together. The margins are united by a double passage of the suture, without tying any knots. The sutures are tied on the bladder’s surface using Lapra-Ty clips fixed at a certain distance from where to two mucosal margins have been joined. We carried out this technique on 90 patients who underwent laparoscopic extraperitoneal radical prostatectomy. The good joining of the margins, the absence of knots and the minimum trauma to the urethral wall together enable to create an anastomosis that is both “sealed” and “tension free”, allowing a quick “welding” of the margins and an early catheter removal. Regarding urinary continence, 56.6% (51) of patientswere continent at catheter removal, 87.6% (78) were continent 3 months later and 98.9% (89) were continent after 6 months. In nine patients (10%), an episode of acute urinary retention occurred within 24 h after the removal of the catheter. We did not encounter any cases of vesicourethral anastomosis stenosis

Prospective open-label study on the efficacy and tolerability of a combination of nutritional supplements in primary infertile patients with idiopathic astenoteratozoospermia

Aim of the study: To evaluate with an open-label study the efficacy and safety of a complex of nutritional supplements with antioxidant activity (L-carnitine, acetyl-L-carnitine, fructose, citric acid, selenium, coenzyme Q10, zinc, ascorbic acid, cyanocobalamin, folic acid) in primary infertile patients with idiopathic astenoteratozoospermia. Methods: The study was conducted in a population of 114 infertile men (96 completed the study) diagnosed with idiopathic astenoteratozoospermia since at least 18 months. Patients orally received a formulation (Proxeed - Sigma-Tau) containing L-carnitine 145 mg, acetyl-L-carnitine 64 mg, fructose 250 mg, citric acid 50 mg, selenium 50 mcg, coenzyme Q10 20 mg, zinc 10 mg, ascorbic acid 90 mg, cyanocobalamin 1.5 mcg, folic acid 200 mcg in combination once a day for 4 months. Results: At the end of study, the mean sperm progressive motility showed a statistically significant increase from 18.3 ± 3.8 to 42.1 ± 5.5. Sixteen patients achieved pregnancy during the study. No significant improvement were observed for sperm density and rate of morphologically normal forms. The treatment was well tolerated. Conclusions: Carnitines in association with others functional substances can improve the most important parameters of sperm quality

The thin line that made the difference: a case report on a Bosniak IIF renal cystic mass treated with cyst decortication

Abstract Background Among all benign kidney lesions, renal cysts are the most common type. In the proposed update of 2019, the Bosniak classification of cystic renal masses is used to classify renal masses according to their likelihood of malignancy, both on computed tomography (CT) and on magnetic resonance imaging (MRI). Case presentation A middle-aged Caucasian male presented to our department with chronic right flank pain. Imaging studies revealed a right renal Bosniak IIF cyst, later complicated by traumatic haemorrhage. The patient consequently underwent cyst decortication for symptom relief. Biopsy results from samples taken during the laparoscopic operation revealed ISUP grade 1 cystic clear cell carcinoma. Conclusion The treatment of Bosniak IIF cysts has long been a matter of debate. As a result of scarcity of data on the probability of malignancy in MRI using the new classification, such cysts should be carefully scrutinised and staged before choosing a treatment option. Retroperitoneal seeding should always be considered in interventions involving an incomplete resection margin or cyst drainage

Circulating Tumor Cells Identify Patients with Super-High-Risk Non-Muscle-Invasive Bladder Cancer: Updated Outcome Analysis of a Prospective Single-Center Trial

Clinical behavior of non-muscle-invasive bladder cancer (NMIBC) is largely unpredictable, and even patients treated according to European Association of Urology recommendations have a heterogeneous prognosis. High-grade T1 (HGT1) bladder cancer is the highest-risk subtype of NMIBC, with an almost 40% rate of recurrence and 20% of progression at 5 years. Nomograms predicting risk of recurrence, progression, and cancer-specific survival (CSS) are not available specifically within HGT1 bladder cancer, and the identification of robust prognostic biomarkers to better guide therapeutic strategies in this subgroup of patients is of paramount importance. Strategies to identify putative biomarkers in liquid biopsies from blood and urine collected from patients with bladder cancer have been intensively studied in the last few years

Body mass index and age correlate with antioxidant supplementation effects on sperm quality: Post hoc analyses from a double-blind placebo-controlled trial

Spermatozoa are vulnerable to lack of energy and oxidative stress as a result of elevated levels of reactive oxygen species. Therefore, it is essential that appropriate nutrients are available during maturation. This randomised, double-blind, placebo-controlled trial investigated the effect of 6-month supplementation with carnitines and other micronutrients on sperm quality in 104 subjects with oligo- and/or astheno- and/or teratozoospermia with or without varicocele. Semen analyses were done at the beginning and end of the treatment. In addition to main analyses, post hoc analyses for age and body mass index (BMI) were carried out. Results were interpreted by dividing the population into two age and BMI classes. In 94 patients who completed the study, all sperm parameters increased in supplemented patients compared to the placebo group. A significant (p&nbsp;=&nbsp;.0272) difference in supplementation efficacy was observed for total motility on patients with varicocele and BMI&nbsp;&lt;&nbsp;25. In the same group, also the progressive motility was significantly superior (p&nbsp;=&nbsp;.0159). For Responder analysis, total motility results were confirmed in both the cited group (p&nbsp;=&nbsp;.0066) and in the varicocele group with BMI&nbsp;&lt;&nbsp;25 and age&nbsp;&lt;&nbsp;35 (p&nbsp;=&nbsp;.0078). This study suggests that supplementation is more effective in subjects with varicocele younger than 35&nbsp;years with BMI&nbsp;&lt;&nbsp;25

Reduced intraoperative bleeding during transurethral resection of the prostate: Evaluation of finasteride, vascular endothelial growth factor, and CD34

Finasteride is an antiandrogen that inhibits 5-α- reductase, an enzyme that converts testosterone to dihydrotestosterone. Finasteride significantly reduces intraoperative bleeding when 10 mg/d is administered for 60 days before transurethral resection of the prostate. Our double-blind, randomized, placebo-controlled study evaluated 200 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate. We compared a placebo group (n = 100) with a group (n = 100) administered 5 mg of finasteride twice a day for 8 weeks. We intended to demonstrate the mechanisms and effects of finasteride compared with those of vascular endothelial growth factor, and to evaluate CD34, an immunohistochemical marker of blood vessel density in the prostate. Our results indicated a lower average microvascular density and vascular endothelial growth factor index for hypertrophic prostate in the finasteride group than in the placebo group