Salvatore Mordente

Modified Supine versus Prone Position in Percutaneous Nephrolithotomy for Renal Stones Treatable with a Single Percutaneous Access: A Prospective Randomized Trial

OBJECTIVES To compare operative time, safety, and effectiveness of percutaneous nephrolithotomy in the supine versus prone position in a prospective randomized trial. MATERIAL AND METHODS From October 2005 to June 2007, 75 patients (33 men, 42 women; mean age, 39.3 yr) were prospectively enrolled and randomly divided into group A (39 patients, supine position) and group B (36 patients, prone position). Inclusion criteria were diagnosis of single or multiple renal stones (pelvic-caliceal) treatable with a single percutaneous access, stone diameter >2.5cm, body mass index (BMI) <30kg/m(2), and no contraindications to perform the operation in the prone position. Exclusion criteria were stones in more than one calyx, complete staghorn stones, and coexisting renal anomalies. RESULTS The two groups were comparable in age, BMI, male-to-female ratio, and stone size. No significant difference was ascertained between the two groups in terms of stone-free rate (group A, 88.7% vs. group B, 91.6%, p=0.12), mean blood loss (group A, Delta hemoglobin -2.3g/dl vs. group B, -2.2g/dl, p=0.23), and mean hospital stay (group A, 4.3 d vs. group B, 4.1 d, p=0.18). The only significant difference reported was mean operative time (group A, 43min vs. group B, 68min, p<0.001). No blood transfusions were needed and no organ injuries were reported. CONCLUSIONS In this carefully selected patient population with uncomplicated renal stones, the supine position was similar to the prone position for percutaneous stone removal.

Long-Term Results of Nephron Sparing Surgery for Localized Renal Cell Carcinoma

Several unrandomized studies from the current literature confirm that in selected patients with localized renal cell carcinoma (RCC), nephron sparing surgery (NSS) shows to be as effective as radical surgery. In this regard, we evaluated the data from patients treated by using such a conservative approach with a long-term follow-up. Materials and Methods. We considered 28 patients (19 M, 9 F; median age 54 years) with unilateral, localized, small (< 4 cm) RCC, submitted to NSS from 1988 to 1994. Only 3 of them (10%) were symptomatic at presentation. Oncological follow-up had been conducted with visits every 4 months for the first two years, every six for another three years and then annually. Results. All the patients were clinical stage T1aN0M0 (UICC TNM 2002). Grading was: 10 G1, 10 G2, 8 G3. Mean tumor diameter was 3.2 cm. After a long-term follow-up (mean 10 years, range 8–14), none present local relapse, disease specific survival is 93% and overall survival is 86%. Based on biochemistry, 82% of the remaining patients still have a normal renal function. Conclusions. Given the excellent long-term results and the recognized benefits of elective NSS, this approach should be preferentially adopted in a selected population of patients with small (<4 cm), unilateral, RCC.

A new transportable shock-wave lithotripsy machine for managing urinary stones: a single-centre experience with a dual-focus lithotripter

To assess the efficacy and safety of a transportable extracorporeal shock wave lithotripsy (ESWL) machine, the Modulith SLX‐F2TM (Storz Medical Italia, Rome, Italy), in the management of solitary urinary calculi.

Presenting a case of a mucinous adenocarcinoma of an exstrophic bladder in an adult patient and a review of literature.

BackgroundBladder exstrophy occurs in approximately 1 in 35,000 live births and is associated with an increased incidence of bladder cancer.The primary mucinous adenocarcinoma of the bladder is an extremely rare urologic entity, which is found in less than 2% of all urinary bladder tumours and is often presented as metastatic. This is the first case in literature of a primary mucinous adenocarcinoma of an unreconstructed exstrophic bladder.Case presentationA 55-year old male patient was diagnosed with a primary mucinous adenocarcinoma of an unreconstructed exstrophic bladder. Examination of the entire gastrointestinal tract shown there were not other primary cites. Immunohistochemistry confirmed the nature of the tumour. The patient underwent a radical cystoprostatectomy with en block bilateral pelvic lymphadenectomy, urinary diversion with a cutaneous ureterostomy and epidpadias repair.ConclusionAdult bladder exstrophy and epispadia correction is a very rare practice in urology due the fact that this congenital disease is diagnosed and corrected in neonates. We advocate the radical surgical management, after exclusion of any primary malignant sites related to the gastrointestinal tract.

The forgotten stent: late complication in a patient with neobladder

Encrustation constitutes a serious complication of ureteral stent use and can result in difficult stent removal. We report the case of a patient with a retained ureteral stent for 3 years following a radical cystectomy.

A phytotherapic approach to reduce sperm DNA fragmentation in patients with male infertility

Introduction Infertility affects 50 to 80 million (between 8 and 12% of couples). Male factor is a cause of infertility in almost half of the cases, mainly due to oligoasthenoteratozoospermia. DNA fragmentation is now considered an important factor in the aetiology of male infertility. We studied the effects on semen analysis and on DNA fragmentation of in vivo admnistration of Myo-Inositol and Tribulus Terrestris plus Alga Ecklonia plus Biovis (Tradafertil; Tradapharma Sagl, Swizerland) in men with previously diagnosed male infertility. Materials and Methods Sixty patients were enrolled in the present study and were randomized into two subgroups: the group A who received Myo-inositol 1000 mg, Tribulus Terrestris 300 mg, Alga Ecklonia Bicyclis 200 mg and Biovis one tablet a day for 90 days, and the group B (placebo group) who received one placebo tablet a day for 90 days. The primary efficacy outcome was the improvement of semen characteristics after 3 months’ therapy and the secondary outcome was the reduction of the DNA fragmentation after treatment. Results The groups were homogenous for age, hormonal levels, sperm concentration and all parameters of sperm analysis. Sperm concentration and progressive motility improved after treatment with Tradafertil (3.82 Mil/ml vs. 1.71 Mil/ml; p<0.05; 4.86% vs. 1.00%; p<0.05) as well as the DNA fragmentation (-1.64% vs -0.39%, p<0.001). No side effects were revealed. Conclusions In conclusion, we can affirm that Tradafertil is safe and tolerable. It is a new phytotherapic approach to Oligoasthenoteratospermia (OAT) syndrome that could lead to good results without interacting with hypothalamic–pituitary–gonadal axis.

Percutaneous Lithotripsy: Indications

Although percutaneous nephrolithotomy (PCNL) is more invasive than extracorporeal lithotripsy (ESWL) it still plays an important role in the treatment of renal stones and indications to PCNL are mainly the cases where ESWL gives poor outcome results. When considering the indications to treat a patient affected by a renal stone, we have to evaluate factors related to: the stone, the kidney, the patient, the instruments and finally the urologist. We believe that elective indications to PCNL are: a stone burden >2cm; staghorn and complex stones; stones in hydronephrotic kidneys or associated to UPJ obstruction; lower calyceal stones when >10 mm or in a calyx with an unfavorable anatomy; ureteral stones impacted in the UPJ with severe hydronephrosys; stones in caliceal diverticula.