Aldo Franco De Rose

Traumatic rupture of the corpora cavernosa : New physiopathologic acquisitions

OBJECTIVES To investigate the physiopathologic mechanisms of the rupture of the corpora cavernosa by means of a histologic study of the tunica albuginea. METHODS In 6 patients (age range 28 to 49 years, mean 38) with traumatic penile rupture, samples of the tunica albuginea were taken during corrective surgery far from the site of the lesion. These specimens were analyzed with light microscopy by the same pathologist and compared with other samples of tunica albuginea taken from 7 patients who underwent penile surgery for other reasons. RESULTS Five of the 6 patients with traumatic penile rupture had histologic anomalies of the tunica albuginea (fibrosclerosis in all 5 patients [83%] and phlogistic cellular infiltrations composed of lymphocytes or histiocytes in 3 patients [50%]). Only 1 patient (17%) with traumatic rupture of the corpus cavernosum had a completely healthy tunica albuginea. None of the control specimens revealed any histologic alterations. CONCLUSIONS Structural anomalies could alter the mechanical properties of the tunica albuginea, representing a weakening factor of the corpora cavernosa and thus a predisposing factor for traumatic rupture of the penis. Therefore, patients with anomalous albuginea could undergo penile rupture even at intracavernous pressures inferior to pressures usually necessary to cause rupture in patients with healthy albuginea.

Testicular Sertoli Cell Tumours and Relative Sub-Types

Introduction: Sertoli cell tumours have a rare (0.4–1.5% of all testicular neoplasms) and heterogeneous pathology. The aim of this paper is to analyse the histological classification of Sertoli cell tumours, in order to assess if the three different histotypes – classic type, large cell calcifying Sertoli cell tumour (LCCSCT) and sclerosing Sertoli cell tumour (SSCT) – really present distinctive clinical and prognostic features. Materials and Methods: The current literature was reviewed; Sertoli cell tumour clinical series and single case reports were searched and analysed. Hence, more than 200 classic Sertoli cell tumours, 48 LCCSCTs and only 12 SSCTs were found. The thirteenth SSCT has been found by us in a 34-year-old man. Results: Every single sub-type presents clinical specific characteristics regarding age of onset, bilaterality, focality, abnormal hormone production, correlated systemic symptoms. Ultrasonographic findings, size and – above all – malignant potential. Conclusions: The precise classification of these tumours is not important only histologically: the currently recognised variants really differ in clinical presentation and course. Moreover, LCCSCTs can be further divided in two subgroups with very different clinical behaviour, those in older patients and those associated with well-known syndromes. These clinical and prognostic variables are of great importance when deciding on the therapeutical approach.

Observational Multicentric Trial Performed with Doxazosin: Evaluation of Sexual Effects on Patients with Diagnosed Benign Prostatic Hyperplasia

Introduction: The aim of our study is to verify the effects of doxazosin on sexual function in patients with benign prostatic hyperplasia (BPH). Materials and Methods: We enrolled 102 patients with BPH, selected by nine Italian Urology Departments. Patients were evaluated with the International Prostatic Symptom Score (I-PSS) and divided into two groups: those with intact sexual activity and those with erectile dysfunction. According to the International Index of Erectile Function (IIEF), the second cohort was divided into three subgroups on the basis of the degree of erectile dysfunction degree (severe, moderate or mild). All patients underwent 3 months of therapy with doxazosin. The effects of doxazosin on sexual activity and on voiding symptoms were monitored at 1, 2 and 3 months with IIEF and I-PSS scales. Results: Eighty-six of the 102 initial patients (84%) were monitored until follow-up was completed. The follow-up at 1 month showed a significant decrease in the I-PSS (p < 0.0001) from 20.2 ± 2.01 (base visit) to 13.1 ± 2.21. The mean IIEF was 19.24 ± 6.59 at baseline and 1 month later the score reached 21.44 ± 5.40, thus showing a statistically significant increase (p = 0.0177). This is more evident in the group presenting with severe to moderate erectile dysfunction. I-PSS and IIEF do not significantly change at the 2- and 3-month follow-ups. Conclusions: The use of doxazosin improved sexual function in patients with BPH.

Penile dermal flap in patients with Peyronie's disease: long-term results.

PURPOSE In 1995 a penile dermal flap was described as an ideal operation for penile curvature due to Peyronies disease. We report our experience with penile dermal flaps in patients with penile curvature due to Peyronies disease. MATERIALS AND METHODS Between January 2001 and May 2004, 26 potent white men with Peyronies disease underwent corporoplasty with a penile dermal flap. They were evaluated at 3, 6 and 12 months, and yearly thereafter by determination of penile length changes and residual curvature, and the International Index of Erectile Function-5. RESULTS At the maximum followup (mean 95 months, range 81 to 108) 22 of 26 patients (85%) were available for examination, of whom 14 (63.6%) had no residual curvature, and 2 (9.1%) and 7 (31.8%) had improved and worse erectile function, respectively. Nine patients (40.9%) had inclusion cysts at the surgical site, including 5 who underwent surgical cyst removal with no cyst recurrence. Only 9 of 22 patients (40.9%) were satisfied with the cosmetic and functional outcome. CONCLUSIONS Despite the attractiveness of the operation to our knowledge no other experience with this technique has been reported. Our results differ from those reported, although we tried to exactly follow the original technique of dermabrading the flap with sandpaper. Based on these results we abandoned the penile dermal flap in patients with Peyronies disease.

Arterial priapism and cycling: a new worrisome reality?

Arterial priapism is a rare condition caused by the traumatic formation of an arteriolacunar fistula. We report 2 cases of arterial priapism after cycling injuries. Both patients sustained a violent perineal trauma against the top tube on the bicycle. In both cases, penile detumescence was obtained by superselective arteriographic embolization of the fistula with gelatin sponge or microcoil. The fistula was monolateral in the first case and bilateral in the second. Cycling should be considered a possible risk factor for arterial priapism as it is for urethritis, prostatitis, hematuria, testicular torsion, scrotal and penile numbness, and erectile dysfunction.

Case report: Testicular secondary localization of a multiple myeloma

A 61-old-year man who had 40 months history of recurrent multiple myeloma presented a right testicular mass, which was diagnosed incidentally by scrotal sonography examination. Alpha-feto-protein and beta-human-chorionic-gonadotropin were normal. A right radical orchiectomy was performed. The histological examination showed an intermediate grade plasmacytoma.

Leiomyoma of the deferens: a curious and extremely rare disease

Introduction Leiomyomas are rare benign tumors that can occur in the male urinary tract. We present a unique case of leiomyoma of the vas deferens. Case Description We present the clinical case of a 69-year-old patient with a suspected bulk close to the right epididymis, which turned out to be a leiomyoma of the vas deferens. To our knowledge, it is the fourth case in literature. Conclusions A proper identification and the knowledge of this pathology, even if it is a very unusual event, is necessary to avoid a surgical over treatment and preserve the testicle, by removing only the tumor.

Risk factors for resurgery in men with artificial urinary sphincter: Role of urethral strictures

The aims of the present study were to evaluate the outcome of implantation of an artificial urinary sphincter (AUS) in male patients with iatrogenic urinary incontinence and to analyse possible risk factors for resurgery, with particular focus on the effects of posterior urethral strictures (US).

Kaposi’s sarcoma: An unusual penile lesion in a HIV negative patient

Kaposis sarcoma (KS) of the penis is a very rare lesion and it is usually observed in HIV-infected patients. We introduce a case of KS of the penis in a 75 years old HIV negative patient with a peripheral T-cell lymphoma. He came to our attention with a painful ulcerated red lesion on the glans that stretched from the urethral meatus to the coronal skin. This lesion was found to be a KS balanopreputial in the classical variant. Penile KS must be included in the differential diagnosis of genital diseases especially when the clinical features of the lesion are aspecific and diagnosis can be made histologically by performing a biopsy.

Verruciform xanthoma of the penis: A rare benign lesion that simulates carcinoma

Verruciform xanthoma is a rare and benign condition predominantly affecting the oral cavity, but also skin and female anogenital mucosa. It can be flat, papular-warty or crateriform-cystic. Furthermore it can simulate HPV viral lesion such as condyloma and malignant neoplasia such as verrucous squamous cell carcinoma. An accurate diagnosis is important to avoid overtreatment, considering it is a benign lesion that does not require any radical treatment. We present an extremely rare case of a 64 year-old man with a small, slighty raised, gray reddish-dotted lesion on the left portion of the ventral side of his glans.