Phytotherapy in the treatment of Benign Prostatic Hyperplasia (BPH): between evidence and empiricism

The treatment of Benign Prostatic Hyperplasia (BPH) has been recently approved by different international guidelines like AUA, EAU, NICE, WHO consultation, etc, and drugs as the alpha-blockers and the 5-alpha-reductase inhibitors are widely indicated for this disease. Moreover, little space is given to the anti-cholinergics and recently to the phosphodiesterase type 5 inhibitors. In this field of application, the phytotherapics, in particular Serenoa repens, are less or not recommended, because they are not supported by adequate scientific evidence. However, the use of these molecules is widely diffuse all over the world, achieving the first choice of treatment in some Nations such as the Asians.</br

Contributed Review: Review of thermal methods for space charge measurement

The space charge accumulation phenomenon has garnered great interest over the last two decades because of the increased use of direct current in high voltage electrical systems. In this context, a significant relevance has been achieved by the thermal methods, used for solid dielectrics. This paper presents a review of this non-destructive measurement system used for the measurement of space charge. The thermal pulse method, the thermal step method, and the laser intensity modulation method are described. For each configuration, the principle of operation, the thicknesses analyzed, and the spatial resolution are described, reporting also the main related application

Preliminary geochemical characterization of the Mts. Simbruini karst aquifer (Central Italy)

Mts. Simbruini karst aquifer feeds important springs whose capture contributes to the water supply of Rome City. To improve the geochemical characterization of this aquifer, we analyzed 36 groundwater samples, 29 from springs and 7 from shallow wells, collected in 1996 and 2019. Atomic adsorption spectroscopy, tritration, ionic chromatography and mass spectrometry were the used analytical methods. Ground waters are bicarbonate alkaline-earth type and HCO3 dominance confirms that the aquifer is hosted in carbonate rocks. Total alkalinity vs. cations plot indicates that CO2 driven weathering controls the water chemistry. The probability plots of HCO3, cations and Ca2+ +Mg2+ indicate four groundwater populations with the less represented one (9 samples) characterized by the highest PCO2 values (>0.3 atm). Most anomalous values of the dissolved PCO2 are from springs located near the center of the studied area. Four samples have negative values of d13CCO2 (about -22‰ vs. PDB), indicating its organic origin, but two other samples have positive values (1.6 and 2.6 ‰ vs. PDB), similar to those observed in the CO2 of deep origin discharged at the close Colli Albani volcano. Therefore, geochemical evidence indicates that the Mts. Simbruini aquifer is locally affected by the input of deep originated CO2, likely rising up along fractures, interacting with a recharge of meteoric origin, as evidenced by its d2H and d18O isotopic signatures

Carcinoma della prostata: prostatectomia radicale nei pazienti over 70

Prostate cancer is one of the most common male cancers in industrialized countries and it occurs mainly in men older than 50 years. In light of a rapidly ageing population it seems certain tha increasingly many septuagenarians with significant life-expectancy will present with prostate cancer to urologist. However currently there is a lack of consensus on prostate cancer and its treatment in the cohort of men ≥ 70 years of age. Although elderly men are often recommended a watchfull waiting option based on lower life expentancy and potentially slow disease progression, recent evidences indicate suggest a potential benefit of radical prostatectomy in selected older patients. The aim of this review is to illustrate the evidences demonstrating the efficacy and safety and of radical prostatectomy in patients over 70. Also, are presented the results of a small Italian study on patients aged ≥ 70 years with clinically localized prostate cancer undergoing radical prostatectomy. The results show that radical prostatectomy is a safe and effective option in elderly patients, with low incidence of complications and recovery of continence in about two-thirds of patients

Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study

Purpose To evaluate outcomes of patients with high risk prostate cancer (PCa) who underwent radical prostatectomy (RP) in a context of a multidisciplinary approach including adjuvant radiation (RT) + androgen deprivation therapy (ADT). Matherials and Methods 244 consecutive patients with high risk localized PCa underwent RP and bilateral extended pelvic lymph node dissection at our institution. Adjuvant RT + 24 months ADT was carried out in subjects with pathological stage ≥ T3N0 and/or positive surgical margins or in patients with local relapse. Results After a median follow-up was 54.17 months (range 5.4-117.16), 13 (5.3%) subjects had biochemical progression, 21 (8.6%) had clinical progression, 7 (2.9%) died due to prostate cancer and 15 (6.1%) died due to other causes. 136 (55.7%) patients did not receive any adjuvant treatment while 108 (44.3%) received respectively adjuvant or salvage RT+ADT. Multivariate Cox proportional hazard analysis showed that pre-operative PSA value at diagnosis is a significant predictive factor for BCR (HR: 1.04, p < 0.05) and that Gleason Score 8-10 (HR: 2.4; p<0.05) and PSMs (HR: 2.01; p < 0.01) were significant predictors for clinical progression. Radical prostatectomy group was associated with BPFS, CPFS, CSS and OS at 5-years of 97%, 90%, 95% and 86% respectively, while adjuvant radiation + androgen deprivation therapy group was associated with a BPFS, CPFS and CSS at 5-years of 91%, 83%, 95% and 88%, without any statistical difference. Conclusions Multimodality tailored treatment based on RP and adjuvant therapy with RT+ADT achieve similar results in terms of OS after 5-years of follow-up

Tailored treatment including radical prostatectomy and radiation therapy + androgen deprivation therapy versus exclusive radical prostatectomy in high-risk prostate cancer patients: results from a prospective study

Purpose To evaluate outcomes of patients with high risk prostate cancer (PCa) who underwent radical prostatectomy (RP) in a context of a multidisciplinary approach including adjuvant radiation (RT) + androgen deprivation therapy (ADT). Matherials and Methods 244 consecutive patients with high risk localized PCa underwent RP and bilateral extended pelvic lymph node dissection at our institution. Adjuvant RT + 24 months ADT was carried out in subjects with pathological stage ≥ T3N0 and/or positive surgical margins or in patients with local relapse. Results After a median follow-up was 54.17 months (range 5.4-117.16), 13 (5.3%) subjects had biochemical progression, 21 (8.6%) had clinical progression, 7 (2.9%) died due to prostate cancer and 15 (6.1%) died due to other causes. 136 (55.7%) patients did not receive any adjuvant treatment while 108 (44.3%) received respectively adjuvant or salvage RT+ADT. Multivariate Cox proportional hazard analysis showed that pre-operative PSA value at diagnosis is a significant predictive factor for BCR (HR: 1.04, p < 0.05) and that Gleason Score 8-10 (HR: 2.4; p<0.05) and PSMs (HR: 2.01; p < 0.01) were significant predictors for clinical progression. Radical prostatectomy group was associated with BPFS, CPFS, CSS and OS at 5-years of 97%, 90%, 95% and 86% respectively, while adjuvant radiation + androgen deprivation therapy group was associated with a BPFS, CPFS and CSS at 5-years of 91%, 83%, 95% and 88%, without any statistical difference. Conclusions Multimodality tailored treatment based on RP and adjuvant therapy with RT+ADT achieve similar results in terms of OS after 5-years of follow-up

Carcinoma della prostata: prostatectomia radicale nei pazienti over 70

Prostate cancer is one of the most common male cancers in industrialized countries and it occurs mainly in men older than 50 years. In light of a rapidly ageing population it seems certain tha increasingly many septuagenarians with significant life-expectancy will present with prostate cancer to urologist. However currently there is a lack of consensus on prostate cancer and its treatment in the cohort of men ≥ 70 years of age. Although elderly men are often recommended a watchfull waiting option based on lower life expentancy and potentially slow disease progression, recent evidences indicate suggest a potential benefit of radical prostatectomy in selected older patients. The aim of this review is to illustrate the evidences demonstrating the efficacy and safety and of radical prostatectomy in patients over 70. Also, are presented the results of a small Italian study on patients aged ≥ 70 years with clinically localized prostate cancer undergoing radical prostatectomy. The results show that radical prostatectomy is a safe and effective option in elderly patients, with low incidence of complications and recovery of continence in about two-thirds of patients

Perineal-guided endoscopic extraction of ejaculatory duct stones to treat obstructive azoospermia

Objective To report a case of transurethral endoscopic treatment of ejaculatory duct stones with transrectal ultrasound (TRUS)-guided perineal needle implant and ureteroscopic extraction of deferent duct stones in an infertile man. Design Case report. Setting Department of Urology, University of Catania, Italy. Patient(s) A 33-year-old man with azoospermia, low ejaculate volume, perineal discomfort, and unilateral seminal tract dilatation caused by obstructing lithiasis of the ejaculatory and deferent ducts. Intervention(s) Transurethral endoscopic treatment of ejaculatory duct stones with TRUS-guided perineal needle implant and ureteroscopic extraction of deferent duct stones. Main Outcome Measure(s) Improvements in symptoms and seminal parameters. Result(s) The patients had successful relief of symptoms and correction of obstructive azoospermia. Conclusion(s) This new technique allows a more rapid and targeted identification of ejaculatory duct lithiasis, and the ureteroscope enables management of distal seminal stones through the normal anatomic tract

Management of female stress urinary incontinence: a care pathway and update

Stress urinary incontinence (SUI) is a condition characterized by an involuntary loss of urine occurring as result of an increase in intra-abdominal pressure due to effort or exertion or on sneezing or coughing. Estimates of its prevalence in the female population range from 10% to 40%. A literature search of the Medline, Cochrane library, EMBASE, NLH, ClinicalTrials.gov and Google Scholar databases was done up to July 2017, restricted to English-language articles, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape (TVT) and transobturator tape (TOT, TVT-O). Original articles, reviews and meta-analyses were included. Surgical therapy should be considered only after conservative therapies (e.g. an exercise programme or topical estrogens) have failed. Synthetic mid-urethral slings are the gold standard for the surgical treatment of SUI according to the 2016 guidelines of the European Society of Urology (ESU) and the 2017 position statement of the European Urogynaecological Association (EUA). The therapeutic options are numerous but further research into new therapeutic strategies is needed to achieve a better balance between efficacy and adverse events