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Fibrolipomas are an infrequent type of lipomas. We describe a case of a man suffering from subcutaneous penile fibrolipoma, who twelve months earlier has been submitted to augmentative phalloplasty due to aesthetic dysmorphophobia. The same patient three years earlier has been submitted to three-component hydraulic penile prostheses implantation due to erectile dysfunction. After six months from removing of the mass, the penile elongation and penile enlargement were stable, the prostheses were correctly functioning and the patient was satisfied with his sexual intercourse and life. The diagnostics and surgical characteristics of this case are reported.

Erectile dysfunction, the most common male sexual disorder after premature ejaculation, with its important impact on man and partner's 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.

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 Buck's 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.

Objective: Peyronie's 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 Peyronie's 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.

Objective: Penile prosthesis implantation is the solution of choice in patients who have failed or present contraindication to the use of all conservative treatment for erectile dysfunction (ED). Overall, satisfaction rates are high, with more than 80% of patients and partners fully satisfied with cosmetic and functional result of surgery. Chronic postoperative pain, penile shortening, soft or hyposensitive glans, pencil like penis syndrome and difficulty to cycle the device represent the most common causes of patient's dissatisfaction. Satisfaction rates are better assessed with the use of validated questionnaires such as the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) The aim of our study was to analyze the long-term mechanical reliability of the AMS 700CX/CXM inflatable penile prosthesis and the patient's satisfaction rate using IIEF and EDITS questionnaire as standard reference., Materials and Methods: A retrospective case notes review of all patients who have undergone implantation of a three pieces inflatable penile prosthesis AMS 700 CX and CXR between October 1997 and December 2010. Overall, 80 patients have undergone implantation of 3 pieces inflatable penile prosthesis AMS 700 CX InhibiZone. Patients have been administered the IIEF-5 and EDITS questionnaires in combination with a non validated 9 domain questionnaire that assesses penile rigidity, sensation, orgasmic function, frequency of intercourse, impact of surgery on the quality of life, satisfaction rate., Results: Overall 10 years survival estimate according to the Kaplan Meier method of AMS 700 CX touch pump and AMS 700 CX momentary squeeze pump are respectively 77.6% and 82.5%. The median postoperative IIEF5 and EDITS score were respectively 21.46 and 73.11, which show a high level of satisfaction. 59 patients (90.8%) were able to cycle the device and were engaging in penetrative sexual intercourse., Conclusions: Penile prosthesis implantation yields excellent results in terms of cosmetic and functional outcome and therefore has a significant impact on patients' satisfaction, sex life and overall quality of life. Overall, long term reliability has been significantly improved and complication rates are low in the hands of experienced surgeons.

Objective: Our target in this study is to evaluate the efficacy of ultrasound (US)-guided anesthesia in comparison it to the digital-guided one, considering pain and discomfort reduction, during prostate biopsy., Materials and Methods: We analyzed 150 patients that underwent prostate biopsy between March 2011 and January 2012; conditions to enter the sample were: elevated PSA levels and/or psa ratio free/total less than 15% and/or detection of alteration via ultrasound examination and/or a positive outcome of a digital rectal examination. Patients were randomized into two groups. In 75 patients (group A) was performed local US-guided anesthesia with a dose of 10 ml of mepivacaine 1%, in the other 75 patients (group B) a local digital-guided anesthesia was performed, again with an equal dose of 10 ml of mepivacaine 1%. After the biopsy patients were kept under observation for two hours, after that they were asked to provide description of the pain experienced during biopsy, using a 10-point visual analog scale (visual analogue scale; 0 for no pain, 10 for excruciating pain)., Results: In group A, 49 patients scored a VAS value of zero, 23 a value of 1 and 2 a value of 3. On the other side, in group B, 9 patients scored a VAS value of 1, 36 a value of 2, 28 a value of 3 and 2 a value of 4. In comparison patients in group A scored VAS values statistically lower than patients in group B (t student test, p < 0.01)., Conclusions: The ultrasound-guided prostatic anesthesia is preferable to the digital-guided, because it considerably reduce the pain related to this procedure.

Aim of the Study: To evaluate with an open-label study the efficacy and safety of a complex of nutritional supplements with antioxidant activity (L-carnitine, acetyl-L-carnitine, fructose, citric acid, selenium, coenzyme Q10, zinc, ascorbic acid, cyanocobalamin, folic acid) in primary infertile patients with idiopathic astenoteratozoospermia., Methods: The study was conducted in a population of 114 infertile men (96 completed the study) diagnosed with idiopathic astenoteratozoospermia since at least 18 months. Patients orally received a formulation (Proxeed - Sigma-Tau) containing L-carnitine 145 mg, acetyl-L-carnitine 64 mg, fructose 250 mg, citric acid 50 mg, selenium 50 mcg, coenzyme Q10 20 mg, zinc 10 mg, ascorbic acid 90 mg, cyanocobalamin 1.5 mcg, folic acid 200 mcg in combination once a day for 4 months., Results: At the end of study, the mean sperm progressive motility showed a statistically significant increase from 18.3 +/- 3.8 to 42.1 +/- 5.5. Sixteen patients achieved pregnancy during the study. No significant improvement were observed for sperm density and rate of morphologically normal forms. The treatment was well tolerated., Conclusions: Carnitines in association with others functional substances can improve the most important parameters of sperm quality.

Purpose: Controversial data on ESWT (Extracorporeal Shock Wave Therapy) for the treatment of Peyronie's disease are controversial. This study was performed to access the efficacy, reliability and the side-effects of the ESWT., Materials and Methods: From 2000 to 2004, 157 patients with an average age of 58 years and with Peyronie's disease were enrolled for a conservative treatment. All 150 eligible patients were treated with ESWT, using Dornier Compact Delta II UIMS lithotripter. The median number of treatments per patient was 3.5 with the delivery of 2000 shock waves (SW) for each treatment. There was no use of anaesthesia and analgesy. An ultrasound study was made for each patient before treatment. We considered: plaque size, penis curvature, pain, penis rigidity and tumescence, sexual intercourse ability and side-effects. Median follow-up of the study was 36.9 months., Results: Average duration of the treatment was 20 minutes without relevant side-effects. With reference to the curvature, we obtained a significative reduction in 33.3% of the patients, whereas the plaque size was not statistically reduced. Regarding the pain issue we achieved good results with a reduction in more than 90% of the patients and a complete relief in 6%. The quality of the intercourse was reported slightly enhanced. No significant difference was observed in penis tumescence and rigidity., Conclusions: ESWT is a non-invasive treatment for the Peyronie's disease. Our study confirms that the best results are obtained regarding pain and less with the curvature. For the plaque size and quality of sexual intercourse the results are not satisfactory.

Objective: To evaluate diagnostic and therapeutic efficacy of simultaneous ante/retrograde (A/R), trans-scrotal and trans-brachial approach in sclerotherapy of varicocele., Materials and Methods: Between June 2000 and June 2002, 99 patients with varicocele were submitted to simultaneous A/R sclerotherapy of internal spermatic venous plexus. All presented grade III left varicocele, 39 also had right varicocele. Recurrent left varicocele was present in 25 following surgical ligations, in 1 following retrograde sclerosis, in 3 following both surgical and sclerosing techniques. Simultaneous A/R approach was performed using transbrachial percutaneous access for retrograde catheterization which does not obstruct trans-scrotal surgical field. The procedure is performed without need for general anaesthesia., Results: Sclerotherapy of spermatic veins was always completed. At minimum 12 months follow-up (mean 18 months), only 1 failure was observed., Conclusion: Trans-scrotal access allowed to guide, by means of antegrade venography, retrograde selective cannulation of spermatic vein. A/R procedure allows a complete diagnostic evaluation of collateral circulation, with possibility to occlude all vessels draining varicocele. Results at long-term follow-up show very low incidence of recurrence.

Objective: To describe the results of a new simple technique of single transscrotal approach for Tauber antegrade sclerotherapy in bilateral varicocele., Materials and Methods: During the period March 1998-June 2001, overall 341 patients were treated for varicocele using Tauber antegrade sclerotherapy. In 39 of these patients, sclerotherapy was performed bilaterally in the same session whilst in 34, rather than making two incisions at the root of the two hemiscrotums, a single incision was made on the median raphe. During this period, the same approach was used in 4 patients with left varicocele and right hydrocele, 2 patients with left varicocele and right epididymis cyst, 1 patient with bilateral varicocele and bilateral hydrocele, 1 patient with bilateral hydrocele and left varicocele., Results: Maximum ray exposure time was 58 seconds (mean 30). Oro-tracheal intubation was not necessary in any of the patients. In 12 patients, besides local anesthesia, additional sedation was given. Slight bleeding of the wound, occurring in 3 patients, was medicated in the outpatient department., Conclusions: Patients prefer a single incision. When the incision is made on the median raphe, no scars remain. In bilateral varicocele, the single approach reduces invasiveness and increases patient satisfaction.