Marco Vella

ESWL Prediction of Outcome and Failure Prevention

Based on our own experiences and a review of the recent literature, this article evaluates recent developments in predicting outcomes and failures of shockwave lithotripsy when treating patients with urinary tract stones. After a detailed MEDLINE research, the authors identified several variables that influence and predict extracorporeal shockwave lithotripsy (ESWL) success. These variables may be categorized as stone variables, patient variables and operator variables. Only multivariate analysis on a large number of homogenous patients may offer an objective evaluation of the factors conditioning ESWL outcome.

Pathophysiology and Clinical Aspects of Urinary Lithiasis

Urine is a complex balanced solution containing dissociated and non-dissociated solutes. Any variation in urine saturation grade (number of crystals dissolved in a volume of urine), urinary pH and the concentration of crystallization inhibitors can break the normal existing balance and lead to urolithiasis. In the present article we analyze the principal mechanisms (absorptive, renal, resorptive) of hypercalciuria. It will be also shown how heredity directly influences the clinical aspects of cystine, xanthine and oxalate lithiasis and how diet, in association with metabolic disorders, interferes in uric acid and oxalate stone formation. Finally, we report on the roles of urinary tract malformations, urinary tract infections and drugs in the clinical characterization of urolithiasis.

Female genital mutilations: genito-urinary complications and ethical-legal aspects

Many women in the world are still undergoing female genital mutilations (FGMs) even if in almost all the countries, the practice of FGM is illegal. The increase of immigration, particularly from African Countries, to Europe, and Italy too, led to consider this phenomenon with particular attention and skill. All the operators in health services need to know the different types of FGMs and the related complications and the psychological and sexual sequels. Urological complications, in particular, are not rare and the changing anatomy of the external genital apparatus can also make the catheter insertion sometimes difficult. This review analyzes the epidemiology of FGMs, the reasons why the practice is still made, the complications, the ethical, and the principal legal aspects of this practise that must be hopefully early banned.

[S1 Herpes zoster localization: acute urinary retention in woman].

Acute urinary retention in women is rare. The varicella-zoster virus causes inflammatory lesions of the sensory-root ganglions, meninges and, less frequently, spinal cord. Herpes zoster has been reported to affect, although rarely, lower urinary tract innervations, and acute urinary retention can be thought to occur in the presence of sacral dermatome involvement. Usually it is located in S2–4 dermatome and the prognosis for acute urinary retention is benign resolving in about 20 days. We present a case in which the S1 dermatome was interested and acute urinary retention developed. After 10 days of specific therapy and self catheterism the problem resolved.

Relation between sexual dysfunctions and epilepsy, type of epilepsy, type of antiepileptic drugs: a prospective study

Introduction The aim of this study was to evaluate the incidence of sexual dysfunctions in males with epilepsy, the type of epilepsy, the frequency of seizures, the type of antiepileptic drugs (AEDs), the serum hormonal profile and the presence of psychiatric comorbidity. Methods Sixty-one patients focused on type of epilepsy, frequency of seizures, AEDs, hormonal profile and presence of mood disorders. We excluded all patients with severe neurologic and psychiatric impairment and patient who were not able to fill questionnaires. Mean age was 31.2 years (range 18-50 years); 31 patients (50.8%) had an idiopathic generalised epilepsy and 30 (49.2%) a focal epilepsy; among them, latter 18 (60%) had probably symptomatic type and 12 (40%) symptomatic type. Sexual functions were evaluated by “International Inventory of Erectile Function” questionnaire. Results Out of 61 enrolled patients, 22 (36.7%) showed sexual dysfunctions: erectile dysfunctions in 14 (23%), orgasmic dysfunctions in (11.5%) and sexual drive dysfunctions in 12 (19.7%). Out of 61 patients, 36 were subjected to blood measurement of sexual hormones and 21 (58.3%) showed hormonal modifications. Conclusions Sexual dysfunction are present in 36.7% of enrolled males with epilepsy; there is any association between sexual dysfunctions and various AEDs in the treatment, except for carbamazepine (CBZ); there is not any association between sexual dysfunctions and frequency of seizures; hormonal changes are associated with sexual dysfunction in males with epilepsy treated with AEDs but not with the orgasmic dysfunction; there is not any association between hormonal changes and type of AEDs, except for CBZ; depression is associated with sexual dysfunctions.

Urethroplasty with dorsal buccal mucosa graft. Is it still the method of choice in long term urethral stenosis

The aim of our work was to evaluate the long-term changes in symptoms (median 42 months) and to analyze data for any negative predictive factors for the application of the procedure, in patients who underwent to urethroplasty with dorsal buccal mucosa graft. During the period from 2010 to 2015 27 patients were examined. Than they underwent urethroplasty using dorsal buccal mucosa graft (graft of 4 x 2.5 cm). The evaluation of symptoms has been addressed through the application of the IPSS Quality of Life Questionnaire (International Prostatic Symptoms Score) and the evaluation of urinary flow has been carried out by a comparative analysis between the pre- and post-operative uroflowmetry. As our study has shown, data obtained by the screening tests in the post-operative follow-up indicate that there is an increase in the maximum flow of urine until 1 month after surgery. The results in the long-term follow-up are different because they show a partial reduction of the maximum flow although it is maintained around an average value of 23 ml/s being still higher than the maximum flow in the pre-operative period. According to our results it follows that there is a low failure rate of the procedure after a median of 42 months. Only in patients with urethral stenosis longer than 2 cm, a lower long term success is achieved. From what we could observe, this length of the stenosis seems to be the only negative predictive factor for long-term maintenance of a good Quality of Life in patients undergoing the procedure. The results obtained from our study confirm literature data according to which, the gold standard for 2-cm long bulbar urethral stricture whose lumen is well preserved with circumferential spongiofibrosis limited to 1-2 mm is the dorsal graft urethroplasty with buccal mucosa that in our study showed success rates higher of 80% after a median follow up of 42 months and a percentage of relapse-free patients of 82.1% ( median 3.5 years).

Predictive variables of spontaneous micturition recovery after acute urinary retention in men with benign prostatic enlargement: An observational prospective study

Acute urinary retention (AUR) is the sudden and painful inability to urinate spontaneously. AUR is one of the most significant complications of benign prostatic enlargement. The management of AUR is based on transurethral catheterization. Subsequent therapy is uncertain, but AUR seems to benefit from the use of alpha‐blockers. The aim of this study was to evaluate the variables that could predict which patients would recover spontaneous micturition after trial without catheter.

Premature ejaculation: Pharmacotherapy vs group psychotherapy alone or in combination

OBJECTIVES Premature Ejaculation (PE), the commonest sexual dysfunction in males, is generally treated with local anesthetic and SSRI (Dapoxetine). The aim of our study was investigate Group Psychotherapy as an alternative treatment for PE and compare the efficacy of pharmacological treatment and psychotherapy, either alone or in combination, in terms of response and improved Quality of Life (QoL). From a male outpatient population screened for PE, those who received a diagnosis of PE were proposed for the study, enrolled and divided into 3 groups (A, B and C). Each group was treated with Dapoxetine, Group Psychotherapy alone and Dapoxetine and Group Psychotherapy, respectively. MATERIALS AND METHODS Out of 1237 male outpatients, 353 received a diagnosis of Premature Ejaculation. Of them, 279 were enrolled in the study and randomized into 3 groups (A, B and C). Only 157 patients were evaluable. Before and after treatments all participants completed two questionnaires to evaluate PE status and anxiety and referred their IELT. RESULTS GROUP A: The mean post-treatment Premature Ejaculation Diagnostic Tool (PEDT) score decreased from 12.95 to 8.26, while the mean Intra-vaginal Ejaculation Latency Time (IELT) increased from 50.77 sec to 203 sec. (p < 0.05); GROUP B: Reduction in the mean PEDT from 13.44 to 5.11 and an increased IELT from 48.33 to 431.11 sec (p < 0.001); GROUP C: The mean post-treatment PEDT score decreased from 12.29 to 5.57, while the mean IELT increased from 46.86 to 412.14 sec (p < 0.001). All groups recorded an improvement in anxiety. CONCLUSIONS According to our results Group Psychotherapy is an alternative method of treatment for PE. Group Psychotherapy plays a significant role in the treatment of PE, determining a better improvement of symptoms than Dapoxetine alone even if not statistically significant.

An uncommon case of sarcomatoid urothelial carcinoma in covered bladder exstrophy

Abstract We report a case of a woman affected by covered exstrophy, uterus didelphys and external genital malformation presenting with advanced bladder cancer. After neoadjuvant therapy and anterior pelvic exenteration, the abdominal wall was reconstructed with a pedicled myocutaneous muscle-sparing vastus lateralis flap.

Urothelial carcinoma in a pyelocaliceal cyst

che, dalla parete della cisti, protrudono all’interno della cisti stessa. “Cisti complex” sono anche le cisti complicate da emorragia, infezione (dolore e febbre) e rottura (dolore, ematuria e resistenza addominale). L’interesse sotteso alle cosiddette “cisti complex” risiede nella conoscenza che alcune di queste lesioni possono dare origine, o essere già sede di formazioni neoplastiche a partire dallo stesso epitelio della cisti. La differenziazione tra le varie lesioni cistiche renali (semplici, complex e/o tumorali) è molto difficile e RM, ETG e TC sono da sempre utilizzate per provare a dirimere questo problema, ma spesso la diagnosi rimane incerta. Nel 1986 Bosniak propose una classificazione delle cisti basata sulle evidenze TC e delle indicazioni terapeutiche ben precise, col fine di indirizzare l’operatore verso un determinato trattamento, evitando di ricorrere a terapie cruente e poco indicate (3, 4). Oggi la Classificazione di Bosniak, dopo aver subito diverse variazioni (4), si presenta suddivisa in 5 categorie: I, II, IIF, III e IV (Tab. I). Anche se gli studi di Bosniak sono basati su reperti TC, con la RM si ottiene una migliore risoluzione dell’immagine contrastografica e della visualizzazione delle strutture vascolari perilesionali, soprattutto nelle scansioni T2-pesate, più sensibili delle altre tecniche diagnostiche nell’individuazione delle neoformazioni maligne. Recentemente è stata rivalutata l’importanza dell’ecotomografia nelle cisti di categoria IIF, dimostrando l’efficienza della ETG con m.d.c. nel rilevare lesioni neoplastiche all’interno delle cisti e nell’individuazione di versamenti emorragici intra-cistici (3). All’interno della famiglia delle Cisti Renali Complex rientra anche una serie di entità cliniche ben precise, ma di natura completamente differente rispetto alle cisti renali propriamente dette: la Sindrome di Von Hippel-Lindau, la Sclerosi Tuberosa, la Malattia Policistica Autosomica Dominante e Recessiva, il Rene Multicistico Displasico, il Nefroma Cistico e le Cisti Pielogene. Le Cisti Pielogene, o Diverticoli Caliceali, sono delle estroDOI: 10.5301/urologia.5000025Renal complex cysts are lesions whose nature can be either benign or malignant. Depending on the presence of septa, solid components, enhancement or calcifications, they are distinguished according to the Bosniak classification based on CT findings, as well as MRI and ETG. We report a rare case of urothelial carcinoma, originating over a pyelocalyceal cyst in a 50-year-old man, and classified as Bosniak IIF by CT and MRI investigations.