S. De Stefani

Laparoscopic telementored adrenalectomy: The Italian experience

Background:Laparoscopy is widely accepted as the gold standard for adrenalectomy. Telementoring has been developed to reduce the complications associated with surgeon inexperience. We report our preliminary experience with laparoscopic telementored adrenalectomy.M ethods:From July 2002 to May 2003, eight laparoscopic telementored adrenalectomies were performed between two separate operating sites 430 km apart. Six of these procedures were monolateral laparoscopic adrenalectomies, and one was bilateral. All cases were performed by an expert open surgeon who was skilled in laparoscopic procedure but who had no experience in laparascopic adrenalectomyResults:All the procedures were successfully performed in a telementored fashion. The mean operative times, blood loss, and postoperative morbidity results were comparable to those for standard laparoscopic adrenalectomies reported in the literature.Conclusions:This preliminary experience has demonstrated the feasibility of national telementoring. It is a viable method that can potentially add to surgical education and decrease the likelihood of complications due to inexperience with new techniques.

Evaluation of the Effects of Desmopressin in Acute Ureteral Obstruction

Objective: To evaluate the effects of desmopressin on pressure values inside the pelvis and ureter of the rat following acute obstruction. Materials and Methods: By means of a microsurgical technique, 24 male Wistar rats were submitted to ureteral obstruction; pressure inside the ureter was recorded using a cannula and a micrometric glass column. In the treatment group (14 animals) 6 mg/kg of desmopressin were administered 30 min before the beginning of the experiment. Results: Rats pretreated with desmopressin showed a statistically significant reduction in mean intraureteral pressure following acute obstruction (p = 0.05). Conclusions: In Wistar rats desmopressin demonstrated a powerful antidiuretic effect, reducing the intraureteral pressure. The experimental model is useful for a better understanding of physiopathology of renal colic and acute obstruction.

Extracorporeal Shock Wave Lithotripsy in an Elderly Population : How to Prevent Complications and Make the Treatment Safe and Effective

INTRODUCTION The aim of our study is to consider the feasibility and the results of shock wave lithotripsy (SWL) in an elderly cohort of patients, considering different diseases and concomitant morbidity. MATERIALS AND METHODS From January 2003 up to July 2006, a total of 1100 SWL treatments were performed in our Stone Centre with Dornier Lithotripter S device. We retrospectively analyzed all the treatments carried out in patients older than 70 years of age, collecting a total of 130 patients. The average age was 75.1 years (range: 70-89). Stone location was renal in 95 and ureteral in 45 patients. Information about SWL outcomes and complications were collected as well as patients characteristics and treatment modalities. RESULTS Average stone size was 10.2+/-3.4 and 8.7+/-3.1 for the renal and ureteral location, respectively. 73 out of 140 patients (52.1%) were stone free after a single treatment; 49 patients (35%) required an adjunctive session, whereas SWL was unsuccessful in 18 (12.8%) patients. We observed 64, 24, 21, 10, 31 cases of concomitant arterial hypertension, diabetes mellitus, chronic renal failure, solitary kidney condition and previous neoplastic pathologies. A total of 8 and 6 subjects had previous cardiac surgery and atrial fibrillation respectively, thus requiring a warfarin scheduled conversion to low molecular weight heparin. Five patients had a pace maker implant and three patients an abdominal aortic aneurism. No SWL-related complications were found in this series considering both urological and systemic features. CONCLUSION SWL represents the treatment of choice for urolithiasis, and it has to be recommended especially to geriatric patients. In those subjects, SWL complications can be avoided with a proper and personalized preparation, together with an ECG and ultrasound continuously monitored procedure.

Experimental varicocele in the rat: early evaluation of the nitric oxide levels and histological alterations in the testicular tissue

The relationship between varicocele and male infertility remains to be explained. Oxidative damage because of the testicular venous backflow may represent one of the causes of gonad injury and seems to precede the histological alteration. Therefore measuring the values of spermatic or intratesticular nitric oxide (NO) could be useful in evaluating this oxidative distress. The aim of this study is to assess the role of testicular NO in early detection of the damages induced by an experimental varicocele in the Wistar rat. A left varicocele was induced in 10 animals (group A). A control group of 10 rats was performed (group B). Animals were killed 3 months after the operation. Both testicles were harvested, weighed and sectioned in two equal parts: one for the evaluation of the NO level and the other one for histological examination. All the rats in group A showed a conspicuous dilatation of the left spermatic vein. The histopathological analysis was normal in both the groups. Biochemistry showed a meaningful statistical difference (P < 0.001) in the concentrations of NO among the specimens of the left and right gonads in group A but no difference was found in group B. The increase in NO values and the presence of other oxidant agents represent the first sign of testicular distress and it seems to anticipate histopathological changes. As it is well known that a great difference exist between human and animal sperm, NO could therefore in the future be taken into consideration together with others parameters for the evaluation of patient who is affected by varicocele.

Elective segmental ureterectomy for transitional cell carcinoma of the ureter: long-term follow-up in a series of 73 patients

Study Type – Therapy (outcome)

A knotted multi-length ureteral stent: a rare complication

Ureteral catheters represent essential devices in the management of upper urinary tract obstruction; complications are unusual. Knotting of the stent at its proximal coiled end is a very rare but potentially dangerous event that should be promptly recognized.

Bacille Calmette-Guérin intravesical instillation and erectile function: is there a concern?

The aim of our study was to evaluate the effect of bacille Calmette‐Guérin (BCG) therapy on erectile function in a cohort of male patients affected by non‐muscle invasive bladder cancer. Thirty male patients undergoing BCG treatment for non‐muscle invasive bladder cancer were enrolled in the study. Their mean age was 60.4 years. None of the patients had risk factors for erectile dysfunction (ED). All subjects underwent a BCG standard schedule therapy (once weekly instillation for 6 weeks). International Index of Erectile Function (IIEF‐5) and International Prostate Symptom score (I‐PSS) were addressed to the patients during the treatment schedule (at fourth or fifth instillation) and 1 month after the last instillation. The mean IIEF‐5 score was 17.6 ± 6.7 during therapy and 21.7 ± 2.92 a month after the last instillation (P = 0.008). Baseline ED and the association with lower urinary tract symptoms are variables significantly connected with post‐treatment results (P = 0.016 and 0.00 respectively) whereas the age seems not to be related to ED (P = 0.256). No major side effects were recorded. It is concluded that BCG treatment is effective for prophylaxis of non‐muscle invasive bladder cancer; however, it may induce a high incidence of ED. Although this effect is transient and reversible, erectile failure is another source of psychological distress that adversely affects the quality of life of men undergoing BCG treatment.

Knotted ureteral catheter in an 83-year-old man: case presentation and urological non-invasive management in the elderly.

Ureteral catheters are important devices in the management of upper urinary tract obstruction; severe complications due to insertion or stent permanence are unusual. We report the clinical case and management of a knotted ureteral stent in an 83-year-old man.

Changes in peak systolic velocity induced by chronic therapy with phosphodiesterase type‐5 inhibitor

The aim of this study was to assess the influence of chronic therapy with phosphodiesterase type‐5 inhibitor on penile haemodynamics at colour Doppler ultrasound. Thirty patients affected by erectile dysfunction (ED) of different aetiology tested with the International Index of Erectile Function (IIEF‐5) were evaluated with penile colour Doppler ultrasound during basic and dynamic phases (10 μg PGE1) before and after chronic self‐administration of sildenafil citrate (dosage: 100 mg as required, two to three times a week) for a period of 5–20 months (mean: 12.3). Treatment was interrupted 14–21 days before the second ultrasound evaluation. Peak systolic velocity (PSV) and end‐diastolic velocity (EDV) were recorded by means of colour Doppler; cut off values were 25 and 5 cm s−1 respectively. Data were compared by nonparametric tests. Twenty‐two of the 30 patients showed normal pre‐treatment PSV, while eight of 30 had an insufficient arterial flow. Mean pre‐treatment EDV was 4.7 ± 0.5. After chronic therapy with sildenafil, a global improvement of 10.5% on PSV was seen (P < 0.001), without any statistical difference between patients with normal pre‐treatment peak and those with a borderline one. No statistically significant changes were found for EDV (P = 0.98). It is concluded that chronic therapy with phosphodiesterase‐5 inhibitor results in a significant improvement in PSV values, probably due to a penile chronic vasoactive enhancement.

Knotted urethral catheter in an 80-year-old woman: Prevention and management of this unusual complication

Intravesical catheter knotting represents a rare event, especially described in paediatric literature. We report a case of a catheter knot, occurring in an 80-year-old woman, managed by means of sustained traction.