Use of transvaginal ultrasound in females with primary bladder neck obstruction. A preliminary study.

Introduction and aim: The video-urodynamics study is the principal exam to establish a possible primary bladder neck obstruction (PBNO) condition. While trans-rectal ultrasonography plays an important role in the evaluation of the low urinary tract symptoms (LUTS) and the severity of bladder outlet obstruction (BOO) in men, the use of the transvaginal ultrasound (TVUS) in women with symptoms suggesting BOO remains unclear. We tried to check the utility of the TVUS in women with PBNO condition. Material and methods: We selected female patients which presented BOO without pelvic organ prolapse (POP). According to the data of the video-urodynamic exam we selected the patients with the suspicion of PBNO. A TVUS in basal and during micturition was performed before and after surgery. Results: TVUS showed a closed bladder neck bladder in basal condition and during micturition similarly to the fluoroscopic image during video-urodynamics. The mean distance from bladder neck to the vaginal mucosa resulted 1.3 cm in this patients. Conclusions: TVUS results worthy in the evaluation of patients with PBNO before and after surgery

Macrostructural Alterations of Subcortical Grey Matter in Psychogenic Erectile Dysfunction

Psychogenic erectile dysfunction (ED) has been defined as the persistent inability to attain and maintain an erection sufficient to permit sexual performance. It shows a high incidence and prevalence among men, with a significant impact on the quality of life. Few neuroimaging studies have investigated the cerebral basis of erectile dysfunctions observing the role played by prefrontal, cingulate, and parietal cortices during erotic stimulation. In spite of the well-known involvement of subcortical regions such as hypothalamus and caudate nucleus in male sexual response, and the key role of nucleus accumbens in pleasure and reward, poor attention was paid to their role in male sexual dysfunction. In this study, we determined the presence of grey matter (GM) atrophy patterns in subcortical structures such as amygdala, hippocampus, nucleus accumbens, caudate nucleus, putamen, pallidum, thalamus, and hypothalamus in patients with psychogenic ED and healthy men. After Rigiscan evaluation, urological, general medical, metabolic and hormonal, psychological and psychiatric assessment, 17 outpatients with psychogenic ED and 25 healthy controls were recruited for structural MRI session. Significant GM atrophy of nucleus accumbens was observed bilaterally in patients with respect to controls. Shape analysis showed that this atrophy was located in the left medial-anterior and posterior portion of accumbens. Left nucleus accumbens volumes in patients correlated with low erectile functioning as measured by IIEF-5 (International Index of Erectile Function). In addition, a GM atrophy of left hypothalamus was also observed. Our results suggest that atrophy of nucleus accumbens plays an important role in psychogenic erectile dysfunction. We believe that this change can influence the motivation-related component of sexual behavior. Our findings help to elucidate a neural basis of psychogenic erectile dysfunction

[Transurethral thermotherapy by microwaves in patients with benign obstructive prostatic hypertrophy].

The effect of transurethral microwave thermotherapy (TUMT) with Prostatron in patients with benign prostatic hypertrophy was investigated. Two hundred and one patients were treated between January 1991 and June 1992 after informed consent was signed. The following examinations were carried out at screening: interview (including symptoms score evaluation), physical examination (including digital rectal examination), haematology and blood chemistry (including prostate specific antigen), ECG, chest Xray, kidney, bladder and prostate (transrectal) ultrasound sonography (USS) and uroflowmetry; pressure-flow study was performed in a selected group of patients. All enrolled patients had Madsen symptom score > or = 8; peak flow rate < or = 15 ml/s and post void residual urine < or = 200 ml. Patients with obstructive middle lobe of the prostate, any BPH complication or any suspicion of prostatic carcinoma were excluded from the study. Microwave thermotherapy with Prostatron was carried out according to software generation 2.0 (Prostasoft 2.0), the c10 (black) catheter was used in all patients. Follow-up visits were scheduled at 1 week, 1, 3, 6, 12, 18 months after microwave thermotherapy. Overall short- and long-term morbidity rates were 6.09 and 2.73 per cent, respectively. At 12 months, Madsen score was found to be reduced from 11.7 +/- 4.78 to 4.43 +/- 3.30; maximum flow rate (Qmax) was increased from 8.91 +/- 4.20 to 13.20 +/- 4.86; post void residual urine (PVRU) was reduced from 131 +/- 17.6 to 67.40 +/- 34.50.(ABSTRACT TRUNCATED AT 250 WORDS

Medullary Sponge Kidney and Testicular Dysgenesis Syndrome: A Rare Association

The medullary sponge kidney is also known as Lenarduzzi’s kidney or Cacchi and Ricci’s disease from the first Italian authors who described its main features. A review of the scientific literature underlines particular rarity of the association of MSK with developmental abnormalities of the lower urinary tract and genital tract such as hypospadias and bilateral cryptorchidism. The work presented is the only one in the scientific literature that shows the association between the medullary sponge kidney and the testicular dysgenesis syndrome. A question still remains unanswered: are the MSK and TDS completely independent malformation syndromes occurring, in this case, simultaneously for a rare event or are they different phenotypic expressions of a common malformative mechanism? In the future we hope that these questions will be clarified

Resident training in urology: Bipolar transurethral resection of the prostate - a safe method in learning endoscopic surgical procedure

Introduction: Modern medicine uses increasingly innovative techniques that require more and more capabilities for acquisition. In the urological department is increasing the presence of patients with lower urinary tract symptoms (LUTS) and transurethral resection of the prostate (TURP) is the standard of care in their surgical treatment. We report our surgical experience and learning curve of using bipolar plasmakinetic devices in the training of urological residents to benign prostatic hyperplasia (BPH) treatment. Materials and Methods: 80 patients with benign prostatic enlargement due to BPH were enrolled in the study. TURP has been performed by three urological residents and by an expe- rienced urologist. Patients were evaluated before and 6 months after the endoscopic bipolar plasmakinetic resection using the International Prostate Symptom Score (IPSS), maximum uri- nary flow rate (Qmax), postvoid residual urine (PVR) and prostate specific antigen (PSA). Results: Overall 60 procedures were performed, 18 PlasmaKinetic (PK)-TURP procedures were completed by the three residents. In the other 42 cases the procedures were completed by the experienced urologist. In eight cases there was a capsular perforation and the experienced urol- ogist replaced the resident to complete the resection. No complications have been reported in the procedures completed by the senior urologist. All complications caused by the residents were man- aged intraoperatively without changing the course of the procedure. Statistical differences were observed regarding IPSS, quality of life (QoL), and PVR at 6-month follow-up when procedures completed by urological residents were compared to those completed by the senior urologist. Conclusion: Bipolar device represents appropriate tools to acquire endoscopic skills. It is safe and it can be used at the first experience of BPH treatment by a resident who has not previ- ously approached this endoscopic surgical procedure

Transurethral microwave thermotherapy: Morbidity and complications [TERMOTERAPIA TRANSURETRALE A MICROONDE: MORBIDITA E COMPLICANZE]

Results of a phase II study evaluating safety, side effects and therapeutic activity of transurethral microwave thermotherapy in patients with symptomatic benign prostatic hyperplasia, are reported. 221 patients with Madsen symptom score >8, peak flow rate <15 ml/s and post void residual urine <200 ml were enrolled between January 1991 and April 1992. Microwave thermotherapy was carried out in a single outpatient session; up to 60 watts power output were delivered and urethral and rectal temperature alarms set at 44.5 and 42.5°C, respectively. Patient compliance to microwave thermotherapy was satisfactory and iv sedation was required in only one patient. Modest haematuria and urethrorrhagia occurred for a few hours in all patients, after treatment; clot retention, requiring bladder irrigation for 48 hours, occurred in 1 patient. A Foley catheter was positioned after treatment in 32 patients for acute urinary retention and withdrawn after 10.5 days, on average. Urinary tract infections occurred in 11 patients and were successfully treated. Retrograde ejaculation or stenosis of the ejaculatory ducts were observed in 2 out of 84 patients. At one year, Madsen symptom score decreased on average, from 11.80 ± 4.91 to 4.20 ± 4.41, peak flow rate increased from 8.89 ± 4.22 to 12.90 ± 3.75 ml/s, post void residual urine decreased from 132 ± 17.8 to 47 ± 41.4 ml/s. Transurethral microwave thermotherapy appeared to be, in our experience, a safe technique with negligible morbidity: therapeutic activity proved to be satisfactory in selected patients

An innovative approach to treating vaginal mesh exposure after abdominal sacral colpopexy: endoscopic resection of mesh and platelet-rich plasma; initial experience in three women

Introduction and hypothesis: Polypropylene mesh exposure is uncommon after abdominal sacral colpopexy (ASC), but in case of symptomatic vaginal mesh exposure, surgery is needed. When treating it, care must be taken to completely remove the exposed mesh (EM), saving as much vaginal tissue as possible to avoid a subsequent shortened and narrowed vagina. In this video, we present a minimally invasive technique for treating EM after ASC using endoscopic mesh resection and autologous platelet-rich plasma (PRP) technology. Methods: Three women were referred to our outpatient clinic for vaginal vault mesh exposure after laparoscopic ASC with concomitant hysterectomy. All women underwent endoscopic bipolar PlasmaKinetic resection (BPR) of EM, and PRP gel was delivered in the surgical site to cover the gap left by the resection. Results: Mean operative time was 39.6 min. Surgery was uneventful in all cases. All women recovered sexual function, and nobody experienced relapsed pelvic organ prolapse at 1-year follow-up. Conclusions: Our preliminary results show that BPR and PRP are safe, effective, and feasible for treating vaginal mesh exposure with conservation of anatomy and sexual function

Intrascrotal Abscess, Propionibacterium acnes and Staphylococcus cohnii ssp. cohnii: A Case Report and Review of the Literature

Introduction. The Propionibacterium acnes and the Staphylococcus cohnii ssp. cohnii are occasional pathogenic bacteria. The intrascrotal localization of the Propionibacterium acnes is exceptional. The Staphylococcus cohnii ssp. cohnii is not able to colonize the urogenital apparatus but it is the most frequently responsible for blood culture contamination even if it can sustain, in particular conditions, systemic infections. Case Presentation. We report the case of a 72-year-old man who is under observation for pain and swelling of the left hemiscrotum associated to high fever. The scrotal ultrasound shows the presence of a left intra-scrotal abscess with didymus, epididymis, and intact didymus-epididymis tunicae. The blood culture executed for evening fever during antibiotic therapy has underlined an infection with Propionibacterium acnes. A following blood culture has shown an increase in Staphylococcus cohnii ssp. cohnii. Due to fever the patient has undergone left orchifunicolectomy with inguino-scrotal toilet. The anatomical pathological examination has also shown the presence of nonspecific granulomatous inflammation compatible with Propionibacterium acnes infection. Conclusion. The onset of an intrascrotal abscess likely sustained by Propionibacterium acnes complicated by a possible systemic Staphylococcus cohnii ssp. cohnii suprainfection is an exceptional event that, in our case, has been resolved with surgical toilet