Patrizio Vicini

Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes.

SUMMARY Purpose: To investigate the efficacy and tolerability of oral propionyl-L-carnitine (PLC) plus sildenafil in men with erectile dysfunction (ED) and diabetes unresponsive to sildenafil monotherapy. Materials and methods: Patients with medically documented ED of organic or mixed aetiology and diabetes (type 1 and 2) were randomised to receive oral PLC (2 g/day) plus sildenafil (50 mg twice weekly) (20 patients, Group 1) or sildenafil alone (20 patients, Group 2), in a double-blind, fixed-dose study. All patients had been previously treated unsuccessfully with a minimum of eight administrations of sildenafil. Efficacy was evaluated using the International Index of Erectile Function (IIEF) questionnaire: total score, subscores for questions 3 (Q3; achieving an erection) and 4 (Q4; maintaining an erection) and global efficacy question (GEQ: ‘Has treatment improved your erections?’). Patients Event Logs were also used. Results: After 24 weeks of treatment, mean scores for IIEF Q3 and Q4 had improved significantly in patients of Group 1 (4.25 ± 0.63 and 3.95 ± 1.0) compared with Group 2 (2.9 ± 0.71 and 2.7 ± 0.96) ( p < 0.01). Moreover, the percentage of patients with improved erections (GEQ 68% vs. 23%) and successful intercourse attempts (76% vs. 34%) was significantly increased in Group 1 compared with Group 2 ( p < 0.01). Fourteen (70%) patients in Group 1 and four (20%) in Group 2 reported an increase in mean IIEF EF domain score of ≥ 4 ( p < 0.01). Treatments were well tolerated and no patient discontinued study medication. Two patients in Group 1 reported mild gastric pain. Conclusions: Salvage therapy with PLC plus sildenafil was more effective than sildenafil in the treatment of ED in patients with diabetes refractory to sildenafil monotherapy.

Superselective embolization of bladder arteries in the treatment of intractable bladder haemorrhage

Abstract  Bladder hemorrhage following radiation therapy is a serious complication in patients undergoing this treatment. Several methods have been proposed to control this particular situation; however, results have been far from satisfactory, with the exception of drastic measures such as hypogastric artery ligation and radical cystectomy. We recently used a method of superselective embolization of the bladder arteries which enabled us to control severe intractable bleeding in a patient submitted to bladder irradiation for a transitional cell infiltrating carcinoma. Compared to selective embolization and other methods, the advantages of superselective embolization are a lower recurrence rate concerning bleeding, fewer side‐effects and the possibility of using adaptable embospheres (150–1000 micron) which, on account of their marked plasticity, offer better occlusion of the vessels. For these reasons, superselective embolization of the bladder arteries should be considered as the treatment of choice in intractable bladder hemorrhage.

Minimally invasive infrapubic inflatable penile prosthesis implant for erectile dysfunction: evaluation of efficacy, satisfaction profile and complications

Erectile dysfunction (ED), the second most common male sexual disorder, has an important impact on man sexuality and quality of life affecting also female partner’s sexual life. ED is usually related to cardiovascular disease or is an iatrogenic cause of pelvic surgery. Many non-surgical treatments have been developed with results that are controversial, while surgical treatment has reached high levels of satisfaction. The aim is to evaluate outcomes and complications related to prosthesis implant in patients suffering from ED not responding to conventional medical therapy or reporting side effects with such a therapy. One hundred eighty Caucasian male suffering from ED were selected. The patient population were divided into two groups: 84 patients with diabetes and metabolic syndrome (group A) and 96 patients with dysfunction following laparoscopic radical prostatectomy for prostate cancer (group B). All subjects underwent primary inflatable penile prosthesis implant with an infrapubic minimally invasive approach. During 12 months of follow-up, we reported 3 (1.67%) explants for infection, 1 (0.56%) urethral erosion, 1 (0.56%) prosthesis extrusion while no intraoperative complications were reported. Mean International Index of Erectile Function-5 (IIEF-5) was 8.2±4.0 and after the surgery (12 months later) was 20.6±2.7. The improvement after the implant is significant in both groups without a statistically significant difference between the two groups (P-value 0.65). Mean Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score 1 year after the implant is 72.2±20.7, and there was no statistically significant difference between groups A and B (P-value 0.55). Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach; and the patient and partner satisfaction is very high. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease after surgery common complications (infection and mechanical failure).

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.

Use of local hyperthermia as prophylaxis of fibrosis and modification in penile length following radical retropubic prostatectomy

Objective: The aim of the study was to evaluate the effectiveness of local hyperthermia in reducing possible penile shortening following radical retropubic prostatectomy. Patients and methods: The study population comprised 40 patients, aged 52–74 years, submitted to radical retropubic prostatectomy. Patients were divided into two groups of 20. In Group A, patients were submitted to local hyperthermia 3 weeks after surgery, three times a week, with treatment lasting 30 min. Patients received a total of 10 applications, which reached a local temperature of 39–40°C. A second cycle was repeated after 1 month. In Group B, patients were submitted only to post-operative follow-up once a month. Penile length was measured in all patients both before and 3 months after surgery in the ‘stretching phase’ from the pubo-penile junction to the tip of the glans. Results: In Group A patients (hyperthermia treatment), no variation in penile length was observed in 16 cases (80%), while the reduction ranged from 0.5–1.5 cm in four cases (20%). In Group B, 12 patients (60%) showed a reduction in penile length ranging from 0.5–2.5 cm, while penile length remained unchanged in eight patients (40%). Conclusions: Results of this study demonstrate a mild but statistically relevant reduction in penile shortening following low-grade, externally delivered penile hyperthermia, thus confirming the efficacy of this approach in preventing penile shortening caused by post-ischaemic fibrosis.

Role of hyperthermia in the treatment of Peyronie's disease: a preliminary study.

Objective: Previous experience in the treatment of plaque with hyperthermia in orthopaedics led the authors to investigate the effectiveness of this approach in patients with Peyronies disease. Patients and methods: The study population comprised 60 patients (aged 36–76 years) with advanced Peyronies disease. Patients were divided into two groups (A and B), with 30 in each. Group A patients underwent local hyperthermia treatment, with 30-min treatment sessions twice a week for 5 weeks. Patients received a total of 10 applications, which reached a local temperature of 39–40°C. A second cycle was repeated after a 1-month interval for a total of 20 treatment sessions. Group B patients were treated with intra-plaque infiltrations using 10 mg verapamil; they received one infiltration once a week for 3 months. Differences between the two groups, as well as between variables (before and after treatment), were analysed using Student t-test and Fisher test. Results: Hyperthermia significantly reduced plaque size and penile curvature and led to an increase in mean scores of erectile function (EF) domain, while verapamil had no such effects. Haemodynamic parameters were not significantly modified in either group. Hyperthermia caused significantly fewer side effects than verapamil infiltrations and was significantly more effective in preventing disease progression. There were no significant differences between the two groups in terms of pain reduction during erection. Conclusions: Results of this study stress the efficacy of hyperthermia in the treatment of advanced Peyronies disease.

Geometrical modified nesbit corporoplasty to correct different types of penile curvature: Description of the surgical procedure based on geometrical principles and long-term results

We present the use of a modified corporoplasty, based on geometrical principles, to determine the exact site for the incision in the tunica or plaque and the exact amount of albuginea for overlaying to correct with extreme precision the different types of congenital or acquired penile curvature due to Peyronie’s disease. To describe our experience with a new surgical procedure for the enhancement of penile curvature avoiding any overcorrection or undercorrection. Between March 2004 and April 2013, a total of 74 patients underwent the geometrical modified corporoplasty. All patients had congenital curvature until 90° or acquired stable penile curvature ‘less’ than 60°, that made sexual intercourse very difficult or impossible, normal erectile function, absence of hourglass or hinge effect. Preoperative testing included a physical examination, 3 photographs (frontal, dorsal and lateral) of penis during erection, a 10 mcg PGE1-induced erection and Doppler ultrasound, administration of the International Index of Erectile Function (IIEF-15) questionnaire. A follow-up with postoperative evaluation at 12 weeks, 12 and 24 months, included the same preoperative testing. Satisfaction rates were better assessed with the use of validated questionnaire such as the International Erectile Dysfunction Inventory of the Treatment Satisfaction (EDITS). Statistical analysis with Student’s t-test was performed using commercially available, personal computer software. A total of 25 patients had congenital penile curvature with a mean deviation of 46.8° (range 40–90), another 49 patients had Peyronie’s disease with a mean deviation of 58.4 (range 45–60). No major complications were reported. Postoperative correction of the curvature was achieved in all patients (100%). Neither undercorrection nor overcorrection were recorded. No significant relapse (curvature>15°) occurred in our patients. Shortening of the penis was reported by 74% but did not influence the high overall satisfaction of 92% (patients completely satisfied with their sexual life). The erectile function was analyzed in both groups, Student’s t-test showed a significant improvement in erectile function, preoperative average IIEF-15 scores were 17.43±4.67, whereas postoperatively it was 22.57±4.83 (P=0.001). This geometrical modified Nesbit corporoplasty is a valid therapy which allows penile straightening. The geometric principles make the technique reproducible in multicentre studies.

Penile prosthesis implant for erectile dysfunction: A new minimally invasive infrapubic surgical technique

Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partners sexuality and quality of life is a persistent inability to obtain and maintain an erection sufficient to permit satisfactory sexual performance. Non-surgical treatments with controversial results are usually applyed before surgical treatment that has reached high levels of satisfaction. We describe a new surgical technique to implant three-pieces penile prosthesis in patients suffering from erectile dysfunction (ED) not responding to conventional medical therapy or reporting side effects with such a therapy. Implantation of an inflatable prosthesis, for treatment of ED, is a safe and efficacious approach with high satisfaction reported by patients and partners. Surgical technique should be minimally invasive and latest technology equipment should be implanted in order to decrease common complications and to obtain a better aesthetic result.

Use of inflatable penile prostheses AMS CX with momentary squeeze in a patient with Peyronie’s disease after removal of two previously implanted penile prostheses

OBJECTIVE Peyronies disease (PD) is a fibrotic wound-healing condition of the tunica albuginea that results in penile deformity, curvature, hinging, narrowing and shortening, penile pain, and in some cases, erectile dysfunction (ED). Surgery remains the gold standard treatment option, ensuring the faster and trustworthy treatment. For those patients who have erectile dysfunction and PD, penile prosthesis placement with straightening procedure is the best method to solve both diseases. The aim of this article is to present the use of hydraulic penile prostheses AMS CX with Momentary Squeeze associated with a complete isolation of the neurovascular bundle in a complex case after removal of two previously implanted prostheses in a man suffering from Peyronies disease and erectile dysfunction. MATERIAL AND METHOD A 50 year-old patient underwent two previous prosthetic implants in another hospital. The first implantation was performed using an infrapubic approach followed by placement of a three-component hydraulic penile prosthesis. After six months the prosthesis was removed using an infra-pubic approach and two soft prosthesis Virilis II were implanted during the same surgery. One year after the second operation we implanted a hydraulic penile prosthesis AMS CX with Momentary Squeeze after complete isolation of the neurovascular bundle, fixing the two crural tips at the same level of albuginea of the two corpora cavernosa. RESULT Twelve months after surgery the penis was completely straight without penile shortening and the patient was fully satisfied with his sexual life. CONCLUSION The procedure enabled a perfect alignment of the cylinders along the longitudinal axis and penile prosthetic symmetry to obtain a good penile rigidity and a perfect penile straightening.

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