Antonio Marmo Lucon

Age-related increase of reactive oxygen species in neat semen in healthy fertile men.

OBJECTIVES The effects of advancing paternal age on the male reproductive system are well known, but its effects on fecundity remain controversial. Although oxidative stress is associated with poor semen quality and function, a relationship with advancing male age has not been established. The objective of this study was to analyze the relationship between male age and seminal reactive oxygen species (ROS) levels in men presenting for voluntary sterilization. METHODS We prospectively evaluated 98 fertile men who were candidates for vasectomy. These were divided into 2 age groups: less than 40 years (n = 78) and 40 or more years (n = 20). We used 46 infertile patients as positive controls. Standard semen analysis, seminal leukocyte count and ROS levels were measured in all samples. Fertile men with leukocytospermia were excluded. RESULTS The mean age of the men was 35.1 +/- 5.6 years. Men 40 years and older had significantly higher ROS levels compared with younger men (P <0.001). We observed a positive correlation between seminal ROS levels and age (r = 0.20; P = 0.040). In addition, ROS was negatively correlated with sperm concentration (r = -0.48; P <0.001) and motility (r = -0.21; P = 0.030). CONCLUSIONS Reactive oxygen species levels are significant higher in seminal ejaculates of healthy fertile men older than 40 years. ROS levels in whole ejaculate are significantly correlated to age among fertile men. Because ROS are clearly implicated in the pathogenesis of male infertility, these data suggest that delayed fatherhood may reduce the chances of pregnancy as men become progressively less fertile with age.

Pheochromocytoma : Study of 50 cases

PURPOSE We studied the clinical picture, sensitivity of the biochemical tests and imaging studies, pathological findings, surgical results and followup of patients with pheochromocytoma. MATERIALS AND METHODS The records of 50 patients with pheochromocytoma were identified. Hyperadrenergic symptoms and signs; urinary dopamine, epinephrine, norepinephrine and vanillylmandelic acid levels; serum dopamine, epinephrine and norepinephrine levels; ultrasonography; computerized tomography; magnetic resonance imaging and 131iodine-metaiodobenzylguanidine images were analyzed. The size, weight and malignancy of the tumors, as well as the operative mortality, survival rate and clinical condition of the patients were also studied. RESULTS The hyperadrenergic syndrome alone was found in 90% of the patients, Cushings syndrome alone in 2%, both syndromes in 4%, a palpable abdominal tumor only in 2% and incidental tumors in 2%. The sensitivities of the urinary evaluation in the diagnosis were metanephrines 97%, vanillylmandelic acid 90%, epinephrine 64%, norepinephrine 93% and dopamine 66%. For serum assessment the sensitivities were epinephrine 67%, norepinephrine 93% and dopamine 63%. The sensitivities of the localization examinations were 89, 94, 100 and 88% for ultrasonography, computerized tomography, magnetic resonance imaging and 131I-metaiodobenzylquanidine, respectively. There was only 1 operative death. Of the patients with benign tumors 88% were cured and 12% remained hypertensive with no clinical or biochemical evidence of a hyperadrenergic profile. Of the 8 patients with malignant pheochromocytoma 1 was lost to followup and 3 died of widespread disease (1 without surgery and at 2, 24 and 78 months postoperatively). Of the 4 living patients 3 had no evidence of disease and 1 was well, although with pulmonary metastases.

Clinical, Hormonal and Pathological Findings in a Comparative Study of Adrenocortical Neoplasms in Childhood and Adulthood

PURPOSE We reviewed clinical and laboratory findings in 6 male and 32 female patients with functional adrenocortical neoplasms, and compared pediatric and adult data. MATERIALS AND METHODS Hormonal measurements were performed by radioimmunoassay, histological analysis was based on Weiss criteria and staging was done according to previously established guidelines. RESULTS Children had a higher incidence of virilization (72%), whereas in adults the predominant feature was Cushings syndrome (60%). A high testosterone level was the most common finding in adults and children with virilization followed by high dehydroepiandrosterone sulfate, androstenedione and dehydroepiandrosterone levels. High 11-deoxycortisol levels were frequently associated with tumor recurrence. Cortisol suppression after dexamethasone was altered in 93% of patients with virilization and no clinical features, suggesting autonomous cortisol secretion. CONCLUSIONS No statistically significant relation was noted between tumor weight and prognosis but there was a negative correlation between patient age and prognosis since children had a more favorable followup than adults. Mixed features in both groups resulted in the worst prognosis. A Weiss criteria grade IV or greater correlated well with a poor prognosis in adults but not children, while staging was more reliable in children.

Treatment of Peyronie’s Disease by Incomplete Circumferential Incision of the Tunica Albuginea and Plaque With Bovine Pericardium Graft

OBJECTIVES To study the surgical treatment of Peyronies disease using a single incision in the tunica albuginea and fibrotic plaque and repair of the defect by bovine pericardium graft. METHODS Between April 1999 and May 2001, 33 patients who had had symptoms of Peyronies disease for more than 12 months and whose disease had been stable for more than 6 months underwent surgery. The reason for surgery was deformity of the penis that made sexual intercourse, even with erection, difficult or impossible. Two paraurethral incisions were made in Bucks fascia to separate the neurovascular bundle from the tunica albuginea. An incomplete circumferential incision, forked at the extremities, was made in the tunica albuginea and in the plaque at the point of maximal curvature, followed by a septal incision for the lengthening of the short side of the penis. A bovine pericardium graft was used to repair the defect in the tunica. All procedures were performed by a single surgeon (P.H.E.). The average follow-up time was 19.4 months (range 5 to 30). RESULTS No rejection or retraction of the graft was observed. All patients maintained their state of preoperative erection, with the penis corrected in 87.9% of cases and with discrete curvature (less than 15 degrees ) in 12.1%. All recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.21 cm (range 1 to 4) occurred in the size of the penis. CONCLUSIONS This procedure is effective for all types of penile deformity, regardless of the plaque characteristics.

Renal and Perinephric Abscesses: Analysis of 65 Consecutive Cases

ObjectiveThe objective was to describe the last 10 years’ experience of the diagnosis and treatment of renal, perinephric, and mixed abscesses in an academic reference center.Patients and MethodsThe medical records of 65 patients with renal, perinephric, and mixed abscesses treated at our hospital from January 1992 to December 2002 were reviewed. The data collected included predisposing factors, symptoms, physical examination, initial diagnosis, laboratory and radiologic evaluation, treatment, and clinical outcome.ResultsPerinephric abscesses were found in 33 (50.8%) patients, renal abscesses were found in 16 (24.6%), and 16 (24.6%) had mixed abscesses. Urolithiasis (28%) and diabetes mellitus (28%) were the most common predisposing conditions. The duration of symptoms before hospital admission ranged from 2 to 180 days (mean 20 days). Urine culture was positive in 43% of patients and blood culture was positive in 40% of patients. Most of the perinephric abscesses received an interventional treatment: surgical drainage (24%), percutaneous drainage (42%) or nephrectomy (24%). Most patients were cured (73.3%) on discharge from hospital. Mixed (renal and perinephric) abscess treatment was similar: percutaneous drainage (37.5%), surgical drainage (18.75%) or nephrectomy (37.5%). Most patients were cured (60%) on discharge from hospital. Renal abscesses, however, were treated medically in 69% of patients and 73% were cured on discharge from hospital.ConclusionsPerinephric and mixed abscesses are successfully managed by interventional treatment. Renal abscesses can be managed by medical treatment only, reserving interventional treatment for large collections or patients with clinical impairment. Early diagnosis is an important factor in the outcome of renal and perinephric abscesses.

Tadalafil and Fluoxetine in Premature Ejaculation: Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Introduction: Premature ejaculation (PE) is a common male sexual disorder. An ideal, reliable and effective treatment is desired by many men and couples affected by this condition. Aim: Evaluate if the association of a phosphodiesterase-5 inhibitor, tadalafil, and a selective serotonin reuptake inhibitor, fluoxetine, can prolong the intravaginal ejaculatory latency time (IELT) in men with lifelong premature ejaculation. Methods: Sixty patients with lifelong premature ejaculation and without erectile dysfunction (ED) with IELT less than 90 s were enrolled in the protocol and randomized into 4 groups to use a combination of medications: (1) tadalafil 20 mg plus fluoxetine 90 mg, (2) fluoxetine 90 mg plus placebo, (3) tadalafil 20 mg plus placebo, and (4) two different placebo capsules (control). Before starting the medications, each man timed his IELT with a stopwatch, and likewise during the treatment period. Fluoxetine 90 mg or placebo was taken once a week plus tadalafil 20 mg or placebo within a 36-hour frame of intended sexual intercourse with a steady partner. Patients were prospectively followed for 12 weeks. One-way ANOVA was used for statistical comparisons of IELT results in each group. Results: Mean IELT before starting treatment was 51.3 ± 23 s. Withone-way ANOVA, a statistically significant difference in post-treatment IELT was seen with combination treatment compared to placebo (p < 0.001). There were increases in IELT from baseline in patients using fluoxetine plus tadalafil (49.57 ± 25.87 to 336.13 ± 224.77) (p < 0.001), fluoxetine (56.55 ± 18.55 to 233.62 ± 105.08) (p < 0.001) and tadalafil (49.26 ± 19.43 to 186.53 ± 159.05) (p = 0.001). The increases in each group were statistically significant compared to the placebo (49.86 ± 19.43 to 67.82 ± 46.18) (p = 0.042). Conclusion: Fluoxetine plus tadalafil significantly increased the IELT from baseline in men with lifelong premature ejaculation when compared to placebo, tadalafil or fluoxetine.

A single relaxing incision to correct different types of penile curvature: surgical technique based on geometrical principles

Penile curvature, whether caused by Peyronie’s disease or congenitally, leads to reduced functional penile length and may be associated with penile shaft constriction and/ or erectile dysfunction. The current available surgical treatment consists of shortening the healthy tunica albuginea on the long side, invariably associated with loss of penile length [1–5], or lengthening the short side by incision and/or excision of the tunica with graft placement [6–10].

Epidemiology of urogenital tuberculosis worldwide

Objectives:  To characterize the epidemiology of urogenital tuberculosis worldwide and to compare the features of patients from developing countries to those from developed countries.

Microvascular tumour invasion in renal cell carcinoma: the most important prognostic factor.

To evaluate the role of microvascular invasion (MVI) in the primary lesion for predicting tumour behaviour in patients with renal cell carcinoma (RCC), as reliable clinical prognostic factors would be very valuable.

URODYNAMIC PRESSURE FLOW STUDIES CAN PREDICT THE CLINICAL OUTCOME AFTER TRANSURETHRAL PROSTATIC RESECTION

PURPOSE We evaluate whether urodynamic evaluation can determine preoperatively the clinical prognosis of patients treated with transurethral prostatic resection as measured by urinary symptom score and quality of life index. MATERIALS AND METHODS A total of 253 patients who previously elected transurethral prostatic resection based on clinical symptoms completed the American Urological Association symptom score and quality of life index, and underwent urodynamic evaluation before and after operation. The patients were divided into 7 groups in accordance with detrusor pressure at maximum urinary flow rate. The preoperative and postoperative symptom score and quality of life index were analyzed in each group. RESULTS Of the patients 42% were not obstructed and could not be distinguished from those who were obstructed preoperatively based on total urinary symptoms (p = 0.95) or subjective impression measured by the quality of life index (p = 0.96). The entire obstructed group demonstrated marked improvement compared to the nonobstructed group (p = 0.018). Analysis of severity also revealed a clear relationship with clinical outcome and subjective satisfaction with obstruction grade, that is the more severely obstructed cases had greater clinical benefit compared to those with little or no obstruction. Furthermore, the nonobstructed subjects did not show any clinical or subjective improvement after transurethral prostatic resection (p = 0.24). CONCLUSIONS Urodynamic studies provide great predictive value of clinical improvement after prostatic relief but they also properly predict the poor clinical results in nonobstructed patients.