Stefano Masciovecchio

Plasmakinetic bipolar versus monopolar transurethral resection of non‐muscle invasive bladder cancer: A single center randomized controlled trial

To compare the safety and the efficacy of plasmakinetic bipolar resectoscope versus conventional monopolar in the transurethral resection of primary non‐muscle invasive bladder cancer.

[Impacts of antibiotic and anti-inflammatory therapy on serum prostate specific antigen in asymptomatic men: our experience].

Introduction The management of “grey zone” elevated Prostate Specific Antigen (PSA) is uncertain. After prostate cancer, benign prostatic hyperplasia and prostatitis may induce PSA increase. PSA reduction, after medical therapy, might identify those patients in whom biopsy can be avoided. The aim of this study was to determine if antibiotic and anti-inflammatory allow avoiding prostate biopsies in patients showing PSA decrease or normalization after medical therapy. Materials and Methods Between January 2009 and May 2011, a total of 31 men with total PSA between 4 and 10 ng/ml were enrolled in this study. Patients with pathological digital rectal examination and clinical symptoms of prostatitis or lower urinary tract infection were excluded from the study. Total PSA, free PSA and free/total PSA were evaluated for all of them. Patients received 1000 mg ciprofloxacin daily for 15 days in combination with 100 mg ketoprofen administered rectally. PSA determinations were repeated two weeks after treatment. SPSS for Windows (version 10.0.7) computer package was used for statistical analysis of the data; a p value <0.05 was considered as level of statistical significance. Results 19 patients (61%) showed a reduction of PSA level after therapy. Initial total PSA and free-PSA levels were 7.41 and 1.24 ng/ml, respectively. After medical therapy total and free PSA decreased to 5.72 and 1.19 ng/ml. Free/total PSA changed from 15.2% to 14.3%. PSA reached a normal range value in 5 patients (16%), while in 26 patients it was persistently >4 ng/ml, it decreased in 14 patients (45%), and increased in 12 (39%). Patients with PSA up to 4 ng/ml reported a prostatic cancer in 28.5% and 41.6% of cases if PSA was respectively decreased or increased from the initial value. Conclusions A combination of antibiotic and anti-inflammatory therapy seems to be a useful way to avoid unnecessary biopsies in patients with PSA range from 4 to 10 ng/ml.

Resident training in urology: Bipolar transurethral resection of the prostate - a safe method in learning endoscopic surgical procedure

INTRODUCTION Modern medicine uses increasingly innovative techniques that require more and more capabilities for acquisition. In the urological department is increasing the presence of patients with lower urinary tract symptoms (LUTS) and transurethral resection of the prostate (TURP) is the standard of care in their surgical treatment. We report our surgical experience and learning curve of using bipolar plasmakinetic devices in the training of urological residents to benign prostatic hyperplasia (BPH) treatment. MATERIALS AND METHODS 80 patients with benign prostatic enlargement due to BPH were enrolled in the study. TURP has been performed by three urological residents and by an expe- rienced urologist. Patients were evaluated before and 6 months after the endoscopic bipolar plasmakinetic resection using the International Prostate Symptom Score (IPSS), maximum uri- nary flow rate (Qmax), postvoid residual urine (PVR) and prostate specific antigen (PSA). RESULTS Overall 60 procedures were performed, 18 PlasmaKinetic (PK)-TURP procedures were completed by the three residents. In the other 42 cases the procedures were completed by the experienced urologist. In eight cases there was a capsular perforation and the experienced urol- ogist replaced the resident to complete the resection. No complications have been reported in the procedures completed by the senior urologist. All complications caused by the residents were man- aged intraoperatively without changing the course of the procedure. Statistical differences were observed regarding IPSS, quality of life (QoL), and PVR at 6-month follow-up when procedures completed by urological residents were compared to those completed by the senior urologist. CONCLUSION Bipolar device represents appropriate tools to acquire endoscopic skills. It is safe and it can be used at the first experience of BPH treatment by a resident who has not previ- ously approached this endoscopic surgical procedure.

Impact of Overactive Bladder on sexual function in women

Introduction Overactive Bladder (OAB) and Urge Urinary Incontinence (UUI) are both debilitating and bothersome conditions. OAB negatively impact on womens quality of life affecting their own ability and personal relationships. Our aim has been to evaluate how OAB and UUI affect womens sexual function and the possible role of antimuscarinic drugs in improving their sexual condition. Materials and Methods From January 2009 to May 2010, 58 women diagnosed with OAB filled in the self-administered questionnaires: Female Sexual Function Index (FSFI), the short form of Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). 33 of them (57%) reported a FSFI score<26,55 and were treated with Solifenacin 5mg. they were re-evaluated with the same questionnaires after three months of therapy. Results The mean FSFI score of 33 patients affected by Female Sexual Disfunction (FSD) was 21,8 (range: 18,6–25,7). The six domains designed to address different aspects of female sexual dysfunctions, sexual desire, satisfaction, orgasm, arousal, lubrication and related pain symptoms, were altered in 48, 33, 21, 15, 12 and 8% of the patients respectively. In 70% of the patients, FSFI score improved of a mean of 5,4 after three months of therapy; UDI-6 and IIQ-7 decreased from 56,3 and 59,9 to 47,6 and 50,2, respectively. Considering women with UUI + OAB or OAB alone, we reported a significant improvement of urinary symptoms and women sexual condition after three months of therapy. Conclusion OAB syndrome was found to cause greater deterioration in women sexual function. Antimuscarinic drugs are the mainstay of pharmacologic treatment of OAB able to improve urinary symptoms, enhance quality of life and female sexual condition.

Transobturator surgery in presence of corona mortis: a study in 13 women.

Purpose Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis damage. The aim of this study is to evaluate safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic-organ prolapse (POP) repair in the presence of corona mortis. Materials and methods Thirteen women with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight women underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by a single experienced pelvic surgeon. Results Surgery was uneventful in all cases. No major bleeding was seen during surgery. No pelvic hematoma was identified 24 hours after the procedure. All women were discharged 1 day after surgery. Conclusions Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.

Imaging of medullary sponge kidney: notes for urologists

The medullary sponge kidney is a malformation characterized by Bellini ducts’ ectasias and often by nephrocalcinosis. Scientific literature demonstrates and emphasizes how the Rx-urography plays a primary role to achieve diagnostic certainty in cases of suspected MSK. Pathognomonic urographic aspects in cases of medullary sponge kidney are defined as “bouquet of flowers”, “bunch of grapes” or “brush”. None of the other methods of imaging available today has the same diagnostic accuracy.

Peri-prostatovesicular smooth muscle tumors of undetermined malignant potential: a case report

Introduction Smooth muscle tumors of undetermined malignant potential (STUMPs) are atypical smooth muscle tumors, most of which derived from uterine tissue. STUMPs of male genitourinary system and of the male pelvic organs are uncommon. Case description In this report, we describe the first case of peri-prostatovesicular STUMP that was treated with laparoscopic excision, in a young asymptomatic man. Conclusions In most cases, the definitive diagnosis can be made only after surgical resection and accurate histological examination. The usefulness of adjuvant chemotherapy remains unclear, and a standardized follow-up protocol has not been described.

An unusual sign for a pelvic lymphocele following radical prostatectomy

Pelvic lymphocele appears as a complication of pelvic lymph node dissection (PLND) performed at the time of radical prostatectomy (RP). We describe the case of a 58-year-old man who underwent radical retropubic prostatectomy and PLND. A couple of months later, the patient manifested insignificant lower urinary tract symptoms (LUTS) associated with a sudden strange hiccough. A contrast computed tomography (CT) scan of the abdomen and pelvis revealed a right pelvic lymphocele extended up to the diaphragm injuring the phrenic nerve. A laparoscopic peritoneal marsupialisation was successfully performed and the related symptoms disappeared. In patients at high and intermediate risk, PLND at the time of RP provides leading staging information for the succeeding treatment decision making.1 In 3%–8% of cases a pelvic lymphocele appears as a complication of the PLND, presenting with several signs which differ from pelvic pain and LUTS to more severe complications like sepsis or lymphatic fistula formation.2,3 No univocal agreement exists related to the extension of lymphadenectomy as a causative effect of clinically relevant lymphoceles; age and the length of the dissection up to the external iliac artery seem to result in a higher risk of symptomatic lymphoceles.4,5 We describe the case of a 58-year-old man who underwent RP and PLND. Two months later, he manifested frequency and a reduced urinary voiding volume associated to a sudden bothersome hiccough. A contrast CT scan of the abdomen and pelvis revealed a right lymphocele extended from the pelvis up to the diaphragm, for an overall length of 15 cm, injuring the phrenic nerve (Figure 1(a), (b)). A laparoscopic peritoneal marsupialisation of the lymphocele was successfully performed, creating a peritoneal window of about 6 × 5 × 8 cm3, and its edges were coagulated. In a couple of months all symptoms regressed included the bothersome hiccough.

An unusual case of massive funicular lipoma

Intrascrotal lipomas are benign diseases that originate from adipose tissue inside the scrotal sac or constituting the scrotal wall itself. Paratesticular spermatic cord lipomas are a rare type of intrascrotal lipomas. A 78 years old patient in good health comes to our attention for massive tense-elastic swelling of left hemiscrotum appeared about 3 years ago and slowly increasing. Ultrasound evaluation of the intrascrotal mass showed inhomogeneous images mainly hyperechoic, not infiltrating the ipsilateral testis and scrotal wall. The ultrasonography found a lipomatous lesion with benign characteristics and a surgical excision has been performed. The lipomatous mass removed presented a size equal to 25 cm x 14 cm x 11 cm and a weight of about 490 gr. The microscopic examination of the tissue showed only the presence of mature adipocytes in the absence of cellular atypia, of other cellular types and of vascular abnormalities.

Medullary Sponge Kidney and Testicular Dysgenesis Syndrome: A Rare Association

The medullary sponge kidney is also known as Lenarduzzis kidney or Cacchi and Riccis disease from the first Italian authors who described its main features. A review of the scientific literature underlines particular rarity of the association of MSK with developmental abnormalities of the lower urinary tract and genital tract such as hypospadias and bilateral cryptorchidism. The work presented is the only one in the scientific literature that shows the association between the medullary sponge kidney and the testicular dysgenesis syndrome. A question still remains unanswered: are the MSK and TDS completely independent malformation syndromes occurring, in this case, simultaneously for a rare event or are they different phenotypic expressions of a common malformative mechanism? In the future we hope that these questions will be clarified.