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Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: “varicocele”, “varicocelectomy”, “sclerotherapy”, “male infertility”, “subfertility”, and “semen abnormalities”. Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.

Introduction Nephroptosis has been defined as renal descent of 5 or more cm on orthostasis. This disease is more frequent in young and slim women. The patient complains pain in upright position, that regress lying down. The therapy consists of surgical treatment. We report the case of a woman treated with retroperitoneoscopic nephropexy.Methods We present the case of a 25–years old woman, affected by lumbar pain in upright position for about 1 year. Ultrasound scan of the abdomen and RX-KUB did not show hydronephrosis nor stones. Both an orthopedic examination and a spinal MRI excluded bone or muscular diseases. Intravenous pyelography and diuretic isotope renography in upright position revealed a renal descent of more than 5 cm, without obstruction of upper urinary tract. The patient underwent a renal color doppler imaging, that showed reduction of right kidney resistive index in upright position. The patient underwent a right retroperitoneoscopic nephropexy. After complete dissection of the perirenal fat from the kidney, three nonabsorbable sutures were placed between the posterior renal capsule and the psoas muscle.Results NO blood loss nor perioperative complications have been observed. One month after the procedure, the patient did not complain any pain. Renal color doppler, performed one month after the nephropexy, showed a normalization of resistive index.Conclusions Symptomatic nephroptosis is a disease that has been questioned in the past. Nowadays, the modern imaging and functional examination available allow to identify the “true” cases of symptomatic nephroptosis. The treatment with retroperitoneoscopic nephropexy is an easy and effective procedure.

The unexpected detection of non palpable hypoechoic testicular lesions has become more frequent thanks to the increased use of trans-scrotal ultrasound (US): patients are often asymptomatic and the objective examination reveals no palpable masses. The different diagnostic, therapeutic approaches vary from radical orchifunicolectomy to simple US follow-up, although the guidelines on the management of these lesions are not defined, yet. The article shows our series of patients with hypoechoic testicular lesions who underwent surgical exploration, with the aid of the operating microscope and histologic test.Materials and Methods 6 patients in total underwent microsurgical exploration of non palpable hypoechoic testicular lesions, from April 2003 to December 2004.Results 4 out of the 6 cases were a left-sided testicular lesion, whereas the 2 remaining cases revealed a right-sided lesion [hypoechoic areas mean size = 3.9 mm (range 2.5 – 16)]. The lesions in all patients could be easily identified and successfully excised thanks to the microsurgical technique. The intraoperative frozen section examination (FSE) showed a benign lesion in 5 cases and an intratubular germ cell neoplasia (ITGCN) in one. Patient with ITGCN underwent radical orchiectomy. The final histological analysis confirmed the frozen section examination report for all the 6 cases. Patients were clinically and ultrasonographically evaluated with a mean follow-up of 15 months. No complication occurred.Conclusion Microsurgical exploration of the testis combined with FSE represents a safe, effective and reliable technique in case of non palpable hypoechoic testicular lesions. This approach leads to significant advantages and should be considered especially in patients with a solitary testis or presenting bilateral lesions, and wishing to father a child.

This paper reports the results of a modified Nesbit procedure, designed to increase precision and to simplify the correction of penile congenital or acquired curvatures.Materials and Methods 58 patients in total were considered candidates for surgical treatment of penile curvature, and underwent a modified corporoplasty procedure involving plication suture on the convex aspect of the penis before tunica albuginea resection. Hospital records and follow-up data were retrospectively reviewed.Results 37 patients were affected by congenital penile curvature (mean angle: 48 degrees - range 40 to 90); they reported difficult vaginal penetration. Another 21 patients suffered from Peyronie's disease, with mean angle penile deformity of 48 degrees (range 40 to 60), but no hourglass deformity or hinge effects. All patients had spontaneous and full erections. Mean operative time ±SD was 62±15 minutes. No intra-operative complications were reported. Penile curvature was completely corrected in all cases. Neither residual curvatures nor hypercorrections were recorded. Regarding erectile function, which was evaluated in the Peyronie's disease group, pre-operative average International Index of Erectile Function-5 score was 17.83±4.17, whereas post-operatively it was 19±4.63 (p >0.036). With regard to overall satisfaction, 3 patients (5%) with Peyronie's disease were unsatisfied.Conclusions This modified corporoplasty procedure has resulted in an improved straightening outcome thanks to the possibility of performing tunica albuginea excision only after the surgeon has made and verified the exact correction in real time. A slight but statistically significant improvement in erectile function was observed in patients with Peyronie's disease.

PCR (Polymerase Chain Reaction) has revolutionized molecular genetics and continues to be applied to many fields of medicine and biology. We used nested real time RT – PCR to detect circulating prostate cells in patients affected by prostate cancer, in order to evaluate a possible clinical role of this technique. We present our initial experience.

The obesity represents an increasing social problem in the Western countries. In Italy, it interests approximately 8% of the population, while 1 Italian on 100 belongs to the category of great obese (BMI 40 kg/m2). In the Western Countries, its prevalence is doubled in the last 10 years and this trend will last for next 50 years. The overfat in pre-pubic region determines several aesthetic and functional alterations that have as common element a false brevity of the penis, defined as “hidden penis”. A standard treatment for hidden penis does not exist; several techniques rather exist, that can be arranged in variable way from case to case in order to let the penis free from the surrounding fat. The case that we describe reports a great obese patient (BMI 42 kg/m2), diabetic, with the penis hidden by the pre-pubic fatty tissue. The severe aesthetic and functional problems have been treated in collaboration with the plastic surgeon.

The antegrade sclerotherapy of spermatic veins suggested by R. Tauber in 1988 is one of the most interesting methods for treating varicocele. This technique consists of isolating and cannulating a dilated spermatic vein and then injecting a sclerosing mixture. The procedure is carried out under local anaesthesia and through a small scrotal incision. Antegrade sclerotheraphy is relatively cheap, easy and quick to perform and seems as reliable as surgical ligation and section of the spermatic veins, which is why, in our opinion, antegrade sclerotherapy plays an important role in treating varicocele. This paper describes our preliminary results.

Interest in “genital aesthetics” has risen in the last few years and has considerably increased the request for surgical procedures for penile lengthening and girth enhancement. In this field, the urologist first has to detect the patients who can benefit from surgery, then he has to choose, case by case, the most reliable surgical strategy. The authors introduce the problem of correct management of the short penis-complaining patient, with particular regard for the condition known as “hidden penis”. In the second part of the paper, they describe a suitable surgical procedure of penile lengthening in cases of hidden penis; the procedure combines the incomplete section of the suspensory ligament of penis with other manoeuvres (such as perigenital lipo-suction, abdominoplasty etc.) in order to obtain the best aesthetic and functional result.