Antonio Vitarelli

Contemporary Urethral Stricture Characteristics in the Developed World

OBJECTIVE To assess the current etiology, features, and natural history of urethral stricture disease in the developed world. MATERIALS AND METHODS We analyzed the data from 1439 male patients with urethral stricture, who had undergone surgical treatment in our referral urethral center from 2000 to 2010. The preoperative evaluation included a detailed clinical history of stricture, uroflowmetry, retrograde and voiding cystourethrography, and urethroscopy. Statistical analysis was done for the stricture site, length, and etiology, patient age, and previous treatments. RESULTS Strictures were posterior in 112 (7.8%) and anterior in 1327 (92.2%). In the anterior group, 439 were penile (30.5%), 675 bulbar (46.9%), 71 penile plus bulbar (9.9%), and 142 panurethral (4.9%). The main causes were iatrogenic in 556 (38.6%), unknown in 515 (35.8%), lichen sclerosus in 193 (13.4%), and trauma in 156 (10.8%). The main iatrogenic strictures were from catheterization in 234 (16.3%), hypospadias repair in 176 (12.2%), and transurethral surgery in 131 (9.1%). The stricture distribution increased until about 45 years and then decreased. Strictures were uncommon in those<20 and >70 years old. The mean length was 4.15 cm; longer strictures were found in those with lichen sclerosus (7.45 cm) or after hypospadias repair (4.42 cm) and catheterization (4.40 cm). The mean length was also greater in the pretreated (4.34 cm) than in the untreated (3.64 cm) strictures. CONCLUSION Urethral stricture in developed countries mainly involves the anterior urethra, in particular the bulbar tract. The most common cause was iatrogenic. Hypospadias repair and lichen sclerosus represent emerging important causes. Finally, urethral stricture is not a disease of the elderly but involves all ages.

Alga Ecklonia bicyclis, Tribulus terrestris, and Glucosamine Oligosaccharide Improve Erectile Function, Sexual Quality of Life, and Ejaculation Function in Patients with Moderate Mild-Moderate Erectile Dysfunction: A Prospective, Randomized, Placebo-Controlled, Single-Blinded Study

We aimed to evaluate the efficacy of oral therapy with alga Ecklonia bicyclis, Tribulus terrestris, and glucosamine oligosaccharide (Tradamix TX1000) in patients with erectile dysfunction (ED) at 3 months of follow-up. From January 2013 to September 2013, 177 patients diagnosed with mild-moderate ED (IIEF-EF < 26) were enrolled in this multicenter, single-blinded, placebo-controlled study and randomized in Group A (Tradamix, n = 87) and Group B (placebo, n = 90). Penile color Doppler ultrasound measures, IIEF-15 questionnaire, male sexual health questionnaire-ejaculation disorder (MSHQ-EjD), and sexual quality of life (SQoL-M) were collected. We observed significant changes of the IIEF-15 in Group A (mean difference: 11.54; P < 0.05) at 3 months versus Group B (P < 0.05). PSV (P < 0.05), IIEF-intercourse satisfaction (P < 0.05), IIEF-orgasmic function (mean P < 0.05), IIEF-sexual desire (P < 0.05), IIEF-overall satisfaction (P < 0.05), MSHQ-EjD (mean difference: 1.21; P < 0.05), and SQoL-M (mean difference: 10.2; P < 0.05) were significantly changed in Group A versus baseline and Group B. Patients with moderate arterial dysfunction showed significant increase of PSV (P < 0.05), IIEF-EF (P < 0.05), MSHQ-EjD (P < 0.05), and SQoL-M (P < 0.05) in Group A. Therapy with Tradamix improves erectile and ejaculation function and sexual quality of life in patients with mild-moderate ED and in particular for those with moderate arterial dysfunction.

Penile fracture: penoscrotal approach with degloving of penis after Magnetic Resonance Imaging (MRI)

Fracture of the penis, a relatively uncommon emergency in Urology, consists in the traumatic rupture of the tunica albuginea of the corpus cavernosum. Examination and clinical history can be highly suspicious of penile fracture in the majority of cases and ultrasonography (USS) can be useful to identify the exact location of the tunical rupture, which is proximal in 2/3 of cases and therefore manageable through a penoscrotal approach. Although expensive and not readily available in the acute setting, Magnetic Resonance Imaging (MRI) may play a role in the differential diagnosis with rupture of a circumflex or dorsal vein of the penis or when the tunical rupture is not associated with tear of the overlying Bucks fascia. This form of imaging is more sensitive than USS at identifying the presence of a tunical tear. The treatment of choice is immediate surgical repair, which allows preserving erectile function and minimizing corporeal fibrosis.

clinical and epidemiological characteristics of young patients with Peyronie's disease: a retrospective study

The average age of men affected by Peyronie’s disease (PD) is approximately 50–55 years, but cases have been reported even in adolescence. Several studies have already investigated the presence of PD in young men, and these studies reported a PD prevalence that varies between 1.5% and 10.8%. Having noticed a greater number of young patients in our centers in recent years, we decided to carry out a retrospective study to evaluate the prevalence of PD in patients aged <40 years, as well as to investigate any possible difference in evolution based on the age of PD patients. We selected a sample of patients (n=271) with a similar time of onset of disease. We then stratified all 271 patients into two groups: group A (age <40 years [n=46]) and group B (age ≥40 years [n=225]). All 271 patients were evaluated for the following variables: penile plaque volume, degree of penile curvature, penile pain, and erectile function. Plaque volume was measured in cm3 by dynamic penile color Doppler sonography after administration of intracavernosal alprostadil 10 mcg. The number of younger patients was 46, accounting for 16.9% of the whole sample. Our study showed more frequent appearance and greater progression of penile curvature in younger patients. The average angle of penile curvature and average score of penile pain intensity in the younger men were significantly higher than in patients aged ≥40 years (P=0.025 and P=0.0001, respectively). In the younger patients, not only was the pain more intense (visual analog scale [VAS] of 5.2 versus 3.8), but it was also more frequently present than in patients aged ≥40 years (78.2% versus 62.2%) (P=0.042). We may conclude that since PD in young patients has a more acute onset and a greater possibility of progression, it should be treated conservatively as soon as it is diagnosed.

Efficacy and safety evaluation of pentoxifylline associated with other antioxidants in medical treatment of Peyronie's disease: a case-control study

Peyronie’s disease (PD) is a chronic disorder involving the tunica albuginea surrounding the corpora cavernosa of the penis. A conservative treatment is indicated in the first stage of disease. The aim of this study was to assess the therapeutic impact and possible side effects of treatment with pentoxifylline (PTX) in combination with other antioxidants in 307 patients with early-stage PD. Patients were subdivided into three groups: A, B, and C. Both groups, A and B, comprising of 206 patients, underwent treatment, whereas Group C was the control group (n=101). Treatment lasted 6 months and included the following: Group A: PTX 400 mg twice a day + propolis 600 mg/d + blueberry 160 mg/d + vitamin E 600 mg/d + diclofenac 4% gel twice/a day + PTX 100 mg via perilesional penile injection/every other week (12 injections in all); Group B: the same treatment as Group A except for the penile PTX injections. After the 6-month treatment course, we obtained the following results: actual mean decrease in plaque volume −46.9% and −24.8% in Group A and B, respectively (P<0.0001); mean curvature reduction −10.1° and −4.8°, respectively (P,0.0001); resolution of pain in 67.6% and 67.2% of cases, respectively (P=0.961); recovery of normal penile rigidity in 56.09% and 23.5% of cases, respectively (P=0.005). After 6 months, progression of disease was observed in all patients belonging to Group C: plaque volume +123.3%; curvature +15.7°; no recovery of penile rigidity. The statistically significant results of our study show that multimodal treatment with PTX in association with other antioxidants and topical diclofenac is efficacious in treating early-stage PD. Furthermore, treatment proved to be more effective when PTX was administered both orally and by penile injection. No serious adverse effects occurred.

Pentoxifylline Associated with Other Antioxidants (Multimodal Therapy) onPatients with Peyronie's Disease. Results of a Controlled Study

Pentoxifylline (PTX) with other antioxidants, in patients with PD enrolled for a conservative medical management. Methods: We carried out a controlled study on 240 patients diagnosed with Peyronies Disease (PD). We have divided two treatment groups, which differ from each other only for the association with PTX-penile injection. Two groups (A and B) were totally composed by 160 PD patients (80 patients for each group): Group A=PTX injection (penile and peri-lesional) 100 mg, every two weeks for six months + PTX 400 mg /oral/ twice daily + propolis 600 mg / oral / daily + blueberries 160 mg /oral/ daily + Vitamin E 600 mg / oral / daily + topical Diclofenac sodium 4% gel / twice a day, for a period of 6 months. Group B=the same therapy of group A but without PTX penile injection. Patients who refused treatment, for various reasons, were included in the control group=Group C (80 patients). Results: In groups A and B after 6 months of treatment a reduction of penile plaque volume of 50.3% and 25.9% respectively was observed, while in group C a mean increase in plaque volume of 131% was observed. Furthermore, in groups A and B, the mean curvature decrease was -11.07° and -4.4° respectively, while in group C a mean increase of curvature =+14.09° was observed. Conclusion: Our results showed that multimodal treatment with PTX associated with antioxidants and topical Diclofenac is significantly effective in treating PD. Treatment outcomes obtained in the treatment-group A are statistically more significant than those achieved in group B. Pentoxifylline is more effective when the treatment program includes both routes of administration: oral + perilesional injection.

PPTLBA-01 QUALITY OF LIFE AFTER PENILE PROSTHESIS IMPLANTATION – 1 YEAR FOLLOW-UP DATA OF THE ITALIAN PROSPECTIVE REGISTRY INSIST-ED

Paolo Capogrosso*, Giovanni Alei, Gabriele Antonini, Antonio Avolio, Antonio Barbieri, Carlo Bettocchi, Marco Bitelli, Francesco Boezio, Masssomo Capone, Enrico Caraceni, Maurizio Carrino, Carlo Ceruti, Sandro Ciampalini, Fulvio Colombo, Enrico Conti, Antonio Corvasce, Giuseppe Dachille, Diego Pozza, Stefano Fiordelise, Alessandro Franceschelli, Giulio Garaffa, Nicola Ghidini, FrancoGiorgio, Emilio Italiano, Giuseppe La Pera, Antonino Lagan a, Giovanni Liguori, Lilia Utizi, Matteo Matera, Nicola Mondaini, Alessandro Natali, Carlo Negro, Fabrizio Palumbo, Matteo Paradiso, Edoardo Pescatori, MassimoPolito,GaiaPolloni, AndreaSalonia,MauroSilvani, AldoTamai, Massimiliano Timpano, Francesco Varvello, Patrizio Vicini, Antonio Vitarelli, Antonio Palmieri, Federico Deh o, Milan, Italy

Urethral injuries secondary to implantation of penile prosthesis. Analysis of the causes, prevention and treatment

Urethral injuries due to penile prosthesis implant represent a rare complication of the intervention to position penile prosthesis, but unfortunately scientific literature about this is poor. This rare complication may occur during surgery and in the postoperative period, both early and late. It recognizes a variety of causes that may include anatomical or functional conditions, for example cavernosal fibrosis or outcomes of inflammations or previous urethral lesions and pathological sensibility due to diabetic neuropathy or other forms of neuropathy including those from spinal cord injury or myelopathy. This review evaluates the possible predisposing conditions, the clinical presentations, and the devices in the surgical procedures to use to minimize the risk of onset of this lesions and the measures to take if they occur.

Urethroplasty in hypoplastic-dysplastic corpus spongiosum and short urethra

Congenital penile curvature and chordee are a rare malformative condition most frequently associated with hypospadias, but varying degrees of penile curvature are observed with an orthotopic meatus. Disease becomes evident after puberty, when curvature becomes more apparent with erection. We present a case of a young man (16 years old), with ventral congenital penile curvature without hypospadias and with hypoplastic-dysplastic corpus spongiosum and short urethra, who could not have normal sexual intercourses. The patient underwent first-stage urethroplasty with urethral opening and graft of buccal mucosa and creation of a temporary hypospadic meatus. No post-operative complications were observed. There were no residual penile curvatures. Results are promising and satisfactory after the first surgical stage and provide a solid ground for the final reconstruction.