A single-operator experience using EchoLaser SoracteLiteTM for focal laser ablation of prostate cancer: One more arrow in the quiver for the conservative management of the disease

Background: The aim of this study was to evaluate the outcomes of patients suffering prostate cancer (PCa) treated conservatively using 1064 nm laser energy for focal laser ablation (FLA). The patients included in the study were unsuitable for surgery or unwilling to receive external beam radiotherapy because they were afraid of the possible side effects of whole-gland therapies. Methods: This study included patients with a diagnosis of nonmetastatic PCa who underwent FLA using SoracteLiteTM system. Tissue ablation was performed at a fixed power of 5 W by the diode multichannel laser system EchoLaser X4 that uses laser light transmitted through optical fibres causing the target tissue to undergo irreversible thermal damage. Functional outcomes were evaluated with the International Prostatic Symptoms Score (IPSS) and 5-item version of the International Index of Erectile Function (IIEF-5) before the treatment and one year later. Results: Ten patients suffering non-metastatic PCa were included. Four decided upon a conservative treatment because of reduced performance status and for six patients the procedure was chosen electively. All patients underwent multiparametric magnetic resonance imaging at 3 and 12 months and eight out of ten patients underwent prostate biopsy at 6 months. Persistent disease was detected in 3 patients who underwent a second ablation. In these patients at the biopsy following the second ablation none harbored residual disease. At follow-up, no patient suffered urinary incontinence requiring the use of pads. No significant worsening in sexual potency measured with IIEF-5 (p = 0.356) or prostatic symptoms measured at IPSS (p = 0.462) were recorded comparing pre-treatment condition vs one-year follow-up. Compared with baseline, prostate-specific antigen was significantly reduced at one-year follow-up (3.7 ± 1.1 vs 7.9 ± 4.1 ng/mL; p = 0.008). Conclusions: Although whole gland therapies remain the gold standard treatment for PCa, our results indicate that the SoracteLiteTM system for focal laser ablation, as a very preliminary step, appears to offer a short-term oncologic control of PCa with negligible side effects

16 years follow-up evaluation of immediate vs delayed vs. combined hormonal therapy on fertility of patients with cryptorchidism: results of a longitudinal cohort study

To investigate in a longitudinal cohort study, the best treatment to preserve fertility in cryptorchid subjects. Patients treated with immediate hormonal vs. delayed vs. combined (hormone plus surgery) therapy consecutively enrolled during the period 1987-1997, were evaluated

Is there a place for nutritional supplements in the treatment of idiopathic male infertility?

Objective: Infertility affects 15% of couples in fertile age. Male factor is a cause of infertility in almost half of cases, mainly due to oligoasthenoteratozoospermia (OAT). The purpose of this study is to review the effects of nutritional supplements as medical treatment for idiopathic male infertility. Material and methods: A Pub Med and Medline review of the published studies utilizing nutritional supplements for the treatment of male infertility has been performed. Results: Clinical trials on Vitamin E, Vitamin A, Vitamin C. Arginine, Carnitine, N-Acetyl-Carnitine, Glutathione, Coenzyme Q10, Selenium and Zinc were reviewed. Although there is a wide variability in selected population, dose regimen and final outcomes, nutritional supplements both alone and in combination seems to be able to improve semen parameters (sperm count, sperm motility and morphology) and pregnancy rate in infertile men. Conclusions: There are rising evidences from published randomized trials and systematic review suggesting that nutritional supplementation may improve semen parameters and the likelihood of pregnancy in men affected by OAT. This improvement, however, is not consistent and there is a wide variation in the treatment regimens used. Well designed and adequately powered RCTs are needed to better clarify the role of nutritional supplements as treatment for male infertility

Tecnica Single Incision Laparoscopic Surgery (SILS) nel trattamento del carcinoma renale

La tecnica Single Incision Laparoscopic Surgery (Sils) è l’evoluzione della chirurgia laparoscopica ed ha lo scopo di ridurre ulteriormente le complicazioni relative alle porte d’accesso della laparoscopia, il dolore post operatorio, la degenza e di migliorare i risultati estetici. Lo scopo del lavoro è dimostrare l’affidabilità e l’efficacia della tecnica Sils per il trattamento del carcinoma renale, sia in caso di nefrectomia parziale che in caso di nefrectomia totale

Role of pharmacologic rehabilitation in the recovery of sexual function following radical prostatectomy.

AIM: The aim of the present study is to evaluate the role of pharmacological postoperative sexual rehabilitation in the recovery of erectile function following radical retropubic prostatectomy. METHODS: Following radical retropubic prostatectomy 113 patients were divided into 2 groups: 77 (group 1) underwent pharmacologic rehabilitation with intracavernous PGE1 starting with 5 mg once or twice weekly beginning 1 month after surgery, followed by oral sildenafil 50-100 mg twice a week after recovery of spontaneous erections, while 36 (group 2) acted as controls. The 2 groups were homogeneous for age and preoperative IIEF5 score, while nerve-sparing techniques were used more frequently in group 1. RESULTS: With 1 year follow-up 42% of group 1 patients have recovered sexual function, versus 8% of group 2 (P < 0.001). The mean recovery time was 7 months, and 56% of rehabilitated patients with bilateral preservation of the neurovascular bundles recovered sexual function, compared to 37.5% of those with unilateral preservation and 28.5% of those operated with non nerve-sparing technique. Intracavernous PGE1 caused pain in 27% of cases. CONCLUSIONS: Pharmacologic rehabilitation significantly impacts on the recovery of sexual function following radical prostatectomy, and the optimal treatment schedule is still to be defined

Epistaxis after PDE-5 inhibitors misuse

A 32-year-old male presented to our department for recurrent epistaxis during sexual intercourses. The patient controlled the bleeding each time with sponge packs and gauzes. During the consultation, he volunteered that the trigger for the epistaxis appeared to have been misuse of phosphodiesterase (PDE)-5 inhibitors, Viagra and Cialis. This first report of epistaxis after PDE-5 inhibitors in a young patient underline the possibility that in the next years the number of similar cases might increase due to the diffusion of PDE-5 inhibitor misuse in recreational setting

Vardenafil mediated image amplification in power doppler ultrasound diagnostics of prostatic diseases

Prostate cancer (PCa) and inflammatory changes in the prostate are associated with an elevated microcirculation density within the involved areas.Transrectal ultrasound with Contrast Enhanced Power Doppler (CEPDU) can provide a valuable diagnostic approach in detecting these areas.Phosphodiesterase-5 inhibitors (PDE5-I) induce nitric oxide (NO) mediated vasodilatation of the prostatic circulation (expecialy in the region of periurethral e bladder neck tissue).The aim of this study is to evaluate PDE5-I capacity on increasing the prostatic microcirculation visibility and hence the capacity to detect suspected areas,similarly as the use of CEPDU. METHODS Ninety-five patients with elevated PSA serum levels and both negative DRE and TRUS,have been recruited for the study since May 2008 until now.All patients underwent CEPDU and successive transrectal ultrasound evaluation with Power-Doppler,1 hr after oral somministration of Vardenafil 20 mg (PDE5-IPD. Areas with increased microcirculation,detected with the use of contrast medium,and those,visible after Vardenafil somministration, were recorded.All patients underwent multiple core prostatic biopsy with double sampling from the areas,indicated as suspected by the methods described above. RESULTS In our study 37/75 patients with prostatic pathology were identified by PDE5-IPD,while 28/75 were identified by CEPDU.PDE5-IPD has resulted in higher diagnostic efficacy in comparison to CEPDU exam.The biopsies performed within the areas identified by PDE5-IPD were 91 with 71.43% of these resulting positive for pathologic changes (PCa or inflammatory changes).The CEPDU exam has led to 110 biopsies with only 52.73% of them resulting positives, while with standard TRUS method 750 biopsies were performed with only 15.6% of cores positive for pathologic areas.In our study PDE5-IPD results more efficient than CEPDU (12% against the difference at 10 % LOC equal to 10.35%) and more sensitive than CEPDU (18,7% against the difference at 10 % LOC equal to 8,68%). CONCLUSIONS The association of Vardenafil and conventional transrectal ultrasound technique with Power Doppler,has reported better results to those obtained with the use of ultrasound contrast medium (CEPDU),confirming though it's high sensitivity to individuate either inflammatory changes,or PCa lesions.Introduction of this association could re-evaluate the utility of contrast medium for ultrasound evaluation of the prostate.The advantages of Vardenafil:durable effect,different mechanism of action, lower invasi