Michelangelo Rizzo

Long-term results of anterior and posterior urethroplasty with actuarial evaluation of the success rates.

PURPOSE We analyzed the long-term results of different urethroplasty techniques. MATERIALS AND METHODS We performed a retrospective review of 98 patients who underwent different procedures for anterior (78) and posterior (20) urethral strictures. Mean followup was 53 months. A total of 20 patients underwent end-to-end anastomosis (group 1), 30 underwent 1-stage procedures (group 2), 28 underwent 2-stage procedures (group 3), and 20 underwent bulboprostatic anastomosis (group 4). The results were analyzed using Kaplan-Meier curves and log rank test. RESULTS The success rate was 95% for group 1, 93.4% for group 2, 78.6% for group 3, and 70% for group 4. Statistical evaluation of the actuarial success rates failed to show significant differences among the 4 groups. CONCLUSIONS The stricture recurrences were uniformly distributed over time. Urethroplasty patients must be followed for the rest of their lives.

Hypospadias: Incidence and Effects on Psychosexual Development as Evaluated with the Minnesota Multiphasic Personality Inventory Test in a Sample of 11,649 Young Italian Men

Purpose: We evaluated the incidence of hypospadias and its effects on psychosexual development in a sample of 11,649 young Italian males. Over the last 30 years only about 30 major publications have addressed these issues and the results of many studies have been contrasting. Some defects in methodology, such as low response rates, heterogeneity of age ranges and the choice of controls, have been the main limitations. Our study was designed to take these problems into account. Materials and Methods: Forty-two hypospadic subjects and a random sample of 500 nonaffected males selected from the large sample of 11,649 young men (>90% of the 18-year-old males living in the Italian region of Tuscany) were screened by the Minnesota Multiphasic Personality Inventory (MMPI) test, psychological interview and clinical evaluation. Results: The incidence of hypospadias in this representative group of Italian men is 3.6/1,000. No difference was noted in the percentage with altered MMPI compared with the control group. The age at surgical corrections and the number of operations are not related to an abnormal global psychological adjustment. Severity of disease influences a more negative genital appraisal and the number of operations is correlated only with more difficulty in initiating contact with the opposite sex. Conclusions: Surgery for hypospadias has to be strongly pursued in as many cases as possible. In addition, we strongly recommend following up all hypospadics, independently of the severity of their genital malformations, through adolescence to early adulthood, to ensure early detection of subjects with impaired psychological profiles.

Prevalence, diagnosis and treatment of prostatitis in Italy: a prospective urology outpatient practice study

To report a prospective, multicentre descriptive study designed to determine the prevalence of the diagnosis of prostatitis in male outpatients examined by urologists in Italy, and to further examine the diagnostic evaluation and treatment of patients identified with a clinical diagnosis of prostatitis.

Pathophysiology of Reno-Ureteral Colic

Introduction: Reno-ureteral colic presents with a complex of acute symptoms that usually indicate the presence of a stone in the collecting system, The aim of any treatment is pain relief, stone removal and preservation of kidney function. We focused our review on the pathophysiological aspects of reno-ureteral colic and, briefly, on its treatment. Materials and Methods: A complete overview of contemporary literature regarding renoureteral colic was performed by using MEDLINE and website on-line publications like EAU Guidelines. Results: Clinical presentation of renoureteral colic, of mechanisms of ureteral peristalsis and pathophysiology of renal colic is described. An overview of the available medical treatments is presented. Conclusions: An accurate comprehension of the pathophysiology of reno-ureteral colic allows the physician to tailor the best treatment for each patient.

Cystic Leiomyosarcoma of the Kidney: An Unusual Clinical Presentation

Primary sarcomas of the kidney are rare, accounting for 1–3% of all renal malignancies. We describe an unusual case of renal leiomyosarcoma in a 41-year-old white woman who presented with a large smooth mass, which was mobile to the overlying structures and which occupied the right hypochondria and flank. Radical nephrectomy was carried out and the patient is well, without symptoms of relapse, 1 year after surgery. Leiomyosarcomas of the kidney have an aggressive and rapidly progressive natural history, with 5-year survival rates of 29–36%. Size <5 cm, low histological grade, absence of lymph node metastases and radical surgical treatment are all associated with a better prognosis. Irradiation and chemotherapy do not appear to alter the clinical course.

Ureteral Intussusception by a Fibroepithelial Polyp

Abstract We report a case of ureteral intussusception caused by a fibroepithelial polyp as a result of forced mucosal sliding. Renal colic was the presenting symptom. Radiologically, it appeared as a pyeloureteral junction obstruction. Pyeloureteral resection was done.

Imperative Indications for Conservative Surgery for Renal Cell Carcinoma: 20 Years’ Experience

Introduction: Radical nephrectomy is the treatment of first choice for unilateral renal cell carcinoma (RCC) with a healthy contralateral kidney; however, the current standard for dealing with RCC in patients with a solitary kidney, bilateral tumor and renal or systemic disease inducing a progressive impairment of renal function is nephron-sparing surgery. Materials and Methods: Between January 1974 and July 1996, 62 patients (39 men and 23 women, 33–77 years old, mean age 60.6 years) with RCC underwent nephron-sparing surgery. The patients were divided in to two groups according to treatment indication: 46 patients with bilateral tumor (n = 21) or solitary kidney (n = 25) and 16 patients with renal or systemic disease that could damage the contralateral kidney. Survival curves were calculated according to the Kaplan-Meyer method. Results: In the first group 3 patients died postoperatively, and 3 were lost to follow-up; 12 patients (27.9%) had malignant recurrence and 5 (11.6%) died of local recurrence or systemic diffusion. The probability of local or systemic tumor recurrence was 9.9% at 2 years, 20.2% at 5 years and 24.7% at 10 years; the probability of survival was 100% at 2 years, 91.9% at 5 years and 81.9% at 10 years. In the second group 3 patients died of unrelated causes and 1 was lost to follow-up; 4 patients (25%) had a malignant recurrence and 2 (12.5%) died of systemic diffusion of RCC. The probability of tumor recurrence was 13.0% at 2 years, 19.7% at 5 years and 26.4% at 10 years, the probability of survival was 100% at 2 years, 93.3% at 5 years and 86.1% at 10 years. Conclusions: In our experience nephron-sparing surgery seems justified in patients with a solitary kidney, bilateral tumor or a disease that potentially damages renal function. Tumor diameter and stage, incidental or symptomatic tumor presentation and specific indication for conservative surgery determine the prognosis.

Cowper's Gland Duct Cyst in an Adult Male: Radiological and Clinical Aspects

A 48-year-old man presenting with perineal pain, weak stream and dysuria was found to have a Cowpers gland duct cyst measuring 1.8 x 3.5 cm, which was investigated with retrograde and voiding urethrography, cavernosography and perineal MRI, which was the single most useful imaging technique. Treatment consisted in complete surgical excision, which allowed an anatomical reconstruction of the urethra. This condition is typical of the pediatric age group, and seldom diagnosed in adults.

Urethral Carcinoma Recurrence in Ileal Orthotopic Neobladder: Urethrectomy and Conversion in a Continent Pouch with Abdominal Stoma

A patient who had previously undergone ileal neobladder with Studer technique presented an urethral recurrence of a transitional cell carcinoma. Further surgical treatment consisted of urethrectomy and creation of an intussuscepted ileal loop which was anastomosed to the pouch and provided a continence mechanism allowing self-catheterization.

Interferon alpha-2a and vinblastine in the treatment of metastatic renal carcinoma

Twenty patients with measurable metastatic renal cell carcinoma (RCC) were treated with interferon alpha-2a (18 X 10(6) IU i.m. 3 times weekly) in combination with vinblastine sulfate (0.1 mg/kg i.v. every 3 weeks). Objective responses in the lungs, bone and liver metastases were observed in 5 of 18 evaluable patients. Dose reduction of interferon alpha-2a (to 9 X 10(6) IU i.m. 3 times weekly) was necessary in 7 patients due to intolerable flu-like side effects and leukopenia (nadir 3,500 leukocytes/mm3). Tolerance was good in 55% of cases. Objective clinical response was observed in 27.7% of patients, and only 38.8% progressed. It is necessary to perform further studies, varying the therapeutic schedules, in order to elicit a better control of the toxic effects and a greater objectiveness of the clinical response.