Alessandro Del Rosso

Plasmakinetic bipolar versus monopolar transurethral resection of non‐muscle invasive bladder cancer: A single center randomized controlled trial

To compare the safety and the efficacy of plasmakinetic bipolar resectoscope versus conventional monopolar in the transurethral resection of primary non‐muscle invasive bladder cancer.

Penile rehabilitation therapy following radical prostatectomy

Purpose. To compare erectile function (EF) recovery of patients treated by early penile rehabilitation therapy (PRT) with sildenafil and with control group. Method. Forty men treated by bilateral nerve sparing radical prostatectomy (NSRP) and with a normal pre-operative EF were enrolled. Fourteen days after surgery, they were randomised to a flexible-dose sildenafil group and to a control group. The International Index of Erectile Function (IIEF) questionnaire was completed before surgery and at 3, 6, 12 and 24 weeks after NSRP. Results. In the group treated, the mean IIEF score before surgery was 26.2 and 14.1, 16.2, 22.5 and 25.2 at 3, 6, 12 and 24 weeks after NSRP, respectively. In the control group, the respective scores were 26.5 and 12.4, 15.8, 15.3 and 17.4. There was a significant difference in IIEF mean score (25 ± 6 vs. 17 ± 9, p < 0.05) and in the potency rate (87% vs. 56%) between the groups at 24 weeks after NSRP. The percentage of patients who were capable of having medication-unassisted intercourse was 54% vs. 21%; 34% vs. 18% of patients had a normal EF with 72% vs. 32% of responders to sildenafil. Conclusions. PRT with PDE-5 inhibitors should be offered early after RP to allow the recovery of EF.

[Impacts of antibiotic and anti-inflammatory therapy on serum prostate specific antigen in asymptomatic men: our experience].

Introduction The management of “grey zone” elevated Prostate Specific Antigen (PSA) is uncertain. After prostate cancer, benign prostatic hyperplasia and prostatitis may induce PSA increase. PSA reduction, after medical therapy, might identify those patients in whom biopsy can be avoided. The aim of this study was to determine if antibiotic and anti-inflammatory allow avoiding prostate biopsies in patients showing PSA decrease or normalization after medical therapy. Materials and Methods Between January 2009 and May 2011, a total of 31 men with total PSA between 4 and 10 ng/ml were enrolled in this study. Patients with pathological digital rectal examination and clinical symptoms of prostatitis or lower urinary tract infection were excluded from the study. Total PSA, free PSA and free/total PSA were evaluated for all of them. Patients received 1000 mg ciprofloxacin daily for 15 days in combination with 100 mg ketoprofen administered rectally. PSA determinations were repeated two weeks after treatment. SPSS for Windows (version 10.0.7) computer package was used for statistical analysis of the data; a p value <0.05 was considered as level of statistical significance. Results 19 patients (61%) showed a reduction of PSA level after therapy. Initial total PSA and free-PSA levels were 7.41 and 1.24 ng/ml, respectively. After medical therapy total and free PSA decreased to 5.72 and 1.19 ng/ml. Free/total PSA changed from 15.2% to 14.3%. PSA reached a normal range value in 5 patients (16%), while in 26 patients it was persistently >4 ng/ml, it decreased in 14 patients (45%), and increased in 12 (39%). Patients with PSA up to 4 ng/ml reported a prostatic cancer in 28.5% and 41.6% of cases if PSA was respectively decreased or increased from the initial value. Conclusions A combination of antibiotic and anti-inflammatory therapy seems to be a useful way to avoid unnecessary biopsies in patients with PSA range from 4 to 10 ng/ml.

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.

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.

Impact of Overactive Bladder on sexual function in women

Introduction Overactive Bladder (OAB) and Urge Urinary Incontinence (UUI) are both debilitating and bothersome conditions. OAB negatively impact on womens quality of life affecting their own ability and personal relationships. Our aim has been to evaluate how OAB and UUI affect womens sexual function and the possible role of antimuscarinic drugs in improving their sexual condition. Materials and Methods From January 2009 to May 2010, 58 women diagnosed with OAB filled in the self-administered questionnaires: Female Sexual Function Index (FSFI), the short form of Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). 33 of them (57%) reported a FSFI score<26,55 and were treated with Solifenacin 5mg. they were re-evaluated with the same questionnaires after three months of therapy. Results The mean FSFI score of 33 patients affected by Female Sexual Disfunction (FSD) was 21,8 (range: 18,6–25,7). The six domains designed to address different aspects of female sexual dysfunctions, sexual desire, satisfaction, orgasm, arousal, lubrication and related pain symptoms, were altered in 48, 33, 21, 15, 12 and 8% of the patients respectively. In 70% of the patients, FSFI score improved of a mean of 5,4 after three months of therapy; UDI-6 and IIQ-7 decreased from 56,3 and 59,9 to 47,6 and 50,2, respectively. Considering women with UUI + OAB or OAB alone, we reported a significant improvement of urinary symptoms and women sexual condition after three months of therapy. Conclusion OAB syndrome was found to cause greater deterioration in women sexual function. Antimuscarinic drugs are the mainstay of pharmacologic treatment of OAB able to improve urinary symptoms, enhance quality of life and female sexual condition.

An unusual case of massive funicular lipoma

Intrascrotal lipomas are benign diseases that originate from adipose tissue inside the scrotal sac or constituting the scrotal wall itself. Paratesticular spermatic cord lipomas are a rare type of intrascrotal lipomas. A 78 years old patient in good health comes to our attention for massive tense-elastic swelling of left hemiscrotum appeared about 3 years ago and slowly increasing. Ultrasound evaluation of the intrascrotal mass showed inhomogeneous images mainly hyperechoic, not infiltrating the ipsilateral testis and scrotal wall. The ultrasonography found a lipomatous lesion with benign characteristics and a surgical excision has been performed. The lipomatous mass removed presented a size equal to 25 cm x 14 cm x 11 cm and a weight of about 490 gr. The microscopic examination of the tissue showed only the presence of mature adipocytes in the absence of cellular atypia, of other cellular types and of vascular abnormalities.

A refined combined antero-retrograde approach for the resolution of a complex ureterovaginal fistula: an endourologic case report.

The onset of a ureterovaginal fistula is a not frequent, though it represents a dreaded and disabling complication of the pelvic surgery. The literature suggests to perform ureteroneocystostomy associated, if necessary, with a bladder suspension technique to Psoas muscle, or endoscopic procedures of ureteral stenting as the “gold standard” to repair this condition. We describe an innovative combined anterograde trans-nephrostomic and retrograde trans-ureteral surgical approach successfully carried out for the treatment of a rare ureterovaginal fistula associated with ipsilateral hydroureteronephrosis secondary to a complete obliteration of the ureteral orifice. We believe that this approach could be considered as a minimally invasive surgical option, an alternative to the traditional ones, for the repair of ureterovaginal fistulae complicated by a complete obliteration of the ipsilateral ureteral meatus.