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This study aimed to evaluate laparoscopic dismembered pyeloplasty compared with open surgery and to determine whether the morbidity and outcome rates are different in each of these techniques. We report our 10-year experience with open and laparoscopic pyeloplasty at one istitution.From February 1999 to October 2010, 49 patients with ureteropelvic junction obstruction were assigned into two groups. 25 patients underwent open surgical pyeloplasty (period 1999-2010) and 24 underwent laparoscopic pyeloplasty (period 2004-2010). 25 patients undergoing open pyeloplasty had a retroperitoneal flank approach. Of the 24 laparoscopic cases 18 had a transperitoneal retrocolic access, 1 had a transperitoneal transmesocolic access and 5 had a retroperitoneal access. In all 49 cases an Anderson-Hynes dismembered pyeloplasty was used. We retrospectively compared the operative time, hospital stay, perioperative complications and follow-up of the two groups. Clinical symptoms were assessed before and after surgery, subjectively.Patients dermographic data were similar between the two groups with mean age of 42 years (range 6-78) and with a male/female ratio of 1:1.45. A crossing vessel could be identified in 37.5\% (9/24) with laparoscopy vs. 32\% (8/25) in open surgery. Compared with open procedures, laparoscopic procedures were associated with a longer mean operating time (274 vs 143 min), a shorter mean hospital stay (9.9 vs 15.8 day) and the perioperative complication rates were 16.7\% for laparoscopic pyeloplasties and 20\% for open pyeloplasties. The success rates were 90.5\% for laparoscopy and 90.9\% for open surgery. Average follow-up was 40.9 month for the laparoscopic group and 72.3 month for the open group. Failed procedures showed no improvement in loin pain or obstruction.The efficacy (in term of success rate and perioperative complications) of laparoscopic pyeloplasty is comparable to that of open pyeloplasty, with shorter mean hospital stay and better cosmetic results. These findings may suggest, that the laparoscopic dismembered pyeloplasty has the potential to replace open surgery and may be considered the first option for the treatment of ureteropelvic junction obstruction in expert hands.

The advantages of minimally invasive surgery are well accepted. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits of the laparoscopic approach. However, the instruments of laparoscopy afford surgeons limited precision and poor ergonomics, and their use is associated with a significant learning curve and the amount of time and energy necessary to develop and maintain such advanced laparoscopic skills is not insignificant. The robotic surgery allows all laparoscopists to perform advanced laparoscopic procedures with greater ease. The potential advantages of surgical robotic systems include making advanced laparoscopic surgical procedures accessible to surgeons who do not have advanced video endoscopic training and broadening the scope of surgical procedures that can be performed using the laparoscopic method. The wristed instruments, x10 magnifications, tremor filtering, scaling of movements and three-dimensional view allow the urologist to perform the intricate dissection and anastomosis with high precision. The robot is not, however, without significant disadvantages as compared with traditional laparoscopy. These include greater expense and consumption of operating room resources such as space and the availability of skilled technical staff, complete elimination of tactile feedback, and more limited options for trocar placement. The current cost of the da Vinci system is $ 1.2 million and annual maintenance is $ 138000. Many studies suggest that depreciation and maintenance costs can be minimised if the number of robotic cases is increased. The high cost of purchasing and maintaining the instruments of the robotic system is one of its many disadvantages. The availability of the robotic systems to only a limited number of centres reduces surgical training opportunities. Hospital administrators and surgeons must define the reasons for developing a robotic surgical program: it is very important to show that robotics will add a dimension that will benefit the hospital, the patient care and institutional recognition. Another essential task to overcome is the important education of the operating room nursing staff, a significant difference between this modality and traditional surgery. Without operating room environment support, most surgeons will revert to traditional methods even after a few successful robotics cases. As the field of robotic surgery continues to grow, graduate medical education and continuing medical education programs that address the surgical robotic learning needs of residents and practicing surgeons need to be developed.

A 57-year-old man presented with a 9-month history of painful left curvature of the penis on erection; he also perceived a thick mass in his penis. There was no history of previous trauma, inflammatory penile involvement or metabolic disorder. A physical examination revealed a solid subcutaneous plaque 6 cm long. Colour Doppler ultrasonography showed an apparent calcification, 50×5 mm, near the septum surrounding the left corpus cavernosum. An X-ray of the penis revealed a large U-shaped ossification completely involving the proximal and the medial part of the septum both on the dorsal and ventral side (Fig. 1). Surgical excision of the plaque Fig. 2. Metaplastic ossification surrounded by fibrotic tissue. ×10. was not possible because it was extensive. The ossifi- cation was fractured using Wilson’s technique [1] and only one case was the disease described as congenital, the penile deformity then corrected by Nesbit’s operation. although it was associated with other anomalies such The ossification was confirmed by microscopy

To date, conventional urodynamic evaluation is not able alone to distinguish motor urgency with uninhibited detrusor contraction from sensory urgency. Transcutaneous electrical localization and reversible monolateral blockade of the 3rd sacral root was performed in 3 women with interstitial cystitis and in 2 men with idiopathic detrusor hyperreflexia by intranerve injection of 6 ml 0.5\% Bupivacaine solution. The paralysis of the detrusor was completely reserved in all patients within 6 hours of the blockade. Cystometry and cystography were performed at 10 min, 2 and 6 hour intervals after the injection. In patients with the urge syndrome resulting from interstitial cystitis, there was a small increase in bladder capacity during the blockade. In contrast, the bladder capacity increased considerably during blockade in patients with idiopathic detrusor hyperreflexia. These results allowed us to differentiate the forms of the syndrome described above.

Microsurgery is becoming increasingly widely accepted in the field of urology, and microsurgical training well become an integral part of the programs for Residents in University Schools of Urology. In this paper we outline the present clinical application of microsurgery in urology and perspectives, for example: workbench surgery, testis transplantation, vasovasostomy, revascularization for impotence, penis replantation, microsurgery of the urinary tract.

Die Kombination der totalen Parathyreoidektomie mit sofortiger Transplantation von autologem Epithelkorperchengewebe in die Beugenmuskulatur des Unterarms stellt eine vorteilhafte Losung des Problems der chirurgischen Behandlung der multiplen Nebenschilddrusenhyperplasie dar. Die Funktion des Implantates ist leicht kontrollierbar und es besteht die Moglichkeit, die endokrine Aktivitat zu steuern, sowohl durch die Entnahme von Gewebsstuckchen in Lokalanasthesie bei erneut auftretendem Hyper parathyreoidismus als auch durch zusatzliche Implantation von tiefgefrorenem aufbewahrtem Gewebe, falls das ursprungliche Transplantat nicht angegangen oder zugrunde gegangen ist.

With the aim of raising awareness with regard to a 'forgotten' health problem and to achieve secondary preventative intervention by means of an early diagnosis, we carried out a study of the prevalence and incidence of urological disease before puberty on a sample of pre-school and school children aged 3, 6 and 9 years. 734 children were recruited from nursery and elementary schools in three different areas of the city of Sassari. Information regarding the nuclear family and any previous disease was obtained by means of a questionnaire previously distributed and explained to the parents. Subsequently, the children were submitted to a urological examination at their schools during school hours; some of them were submitted to more accurate diagnostic tests at the Institute of Clinical Urology of the University. The following diseases were found: preputial adhesion (11.7%), phimosis (8%), enuresis (5.3%), cryptorchism (3.2%), hypospadias (0.5%), varicocele (0.5%), urinary tract infections (0.4%), vesico-urethral reflux (0.3%) and polycystic kidney (0.3%). The same subjects were evaluated, as part of a longitudinal study, a year later. Among the children at nursery school (4 years), there was 1 new case of phimosis. Among the 7 year old age group there were 14 new cases of adhesions, 3 of phimosis, 2 of enuresis and 1 new case of urinary tract infection. Among the 10 year olds there were 3 new cases of varicocele, 2 of adherence, 1 of phimosis and 1 new case of enuresis. The data obtained from the transverse study confirm the marked frequency of urological disease in the age groups under study. The longitudinal study showed, among other things, that the first cases of varicocele occur at 10 years and that enuresis can arise for the first time at any age.

Penile biothesiometry, already employed in the past in the study of penile sensitivity, has recently been proposed as diagnostic rationale for patients suffering from presumably neurogenous impotence. With this method it is possible to verify the integrity of both the somatic sensitivity of the penis and the peripheral sensitivity projected into the cerebral cortex. In this context, an attempt is made to verify whether the biothesiometric test can give useful elements of predictivity for the identification of sensitively undamaged penile areas in patients submitted to previous nerve-sparing surgery of the penis.

Varicocele is a common finding in adolescents and adult men. Its association with male infertility has been well documented: varicoceles are reported to be present in 20\% to 40\% of infertile men. It has been demonstrated that varicocele correction leads to an improvement in the quality of semen in most cases. Percutaneous sclerotization is an established method for treatment of varicocele performed on an outpatient basis. In our report we intend to review our experience in venographic study and transcatheter sclerotherapy based on 560 cases of infertile patients with varicocele. Our study confirms that percutaneous therapy of varicocele may lead to improved spermatogenesis in the majority of patients.

The authors describe a case of renal metastasis from chondrosarcoma originating from the rib, with acute clinical onset characterised by serious anemia secondary to retroperitoneal perirenal hemorrhage. No similar cases have been reported in the literature. The interest of this case lies in both the symptomology of the onset and in the metastatic site. From a diagnostic point of view an intraoperative ultrasound scan was useful, revealing the presence of a roundish neoformation, irregularly hypogenic, with a different appearance from anything observed by the authors in other intraoperative ultrasound examinations of renal masses.

Various authors have investigated the pathological findings of penile tissue after chronic arterial obstruction, but the significance of these changes in the corpora cavernosa remains unclear. In order to evaluate the possible damages in the erectile tissue after chronic arterial obstruction at different levels, we utilized an experimental model in rats to determine the changes in smooth muscle cells and elastic fibers of the erectile tissue by microscopic immunohistochemical and ultrastructural studies.Twelve adult male Wistar rats were employed in this study. Ten were used for the experiments and two as control. The rats were anaesthetized with ether and intraperitoneal 10\% chloral hydrate. Microsurgical isolation of the involved vessels was performed with the aid of a Zeiss dissecting microscope. Partial stenosis was achieved with 11/0 nylon and amputation of the penis was performed at previously established time periods. The partial stenosis was carried out at the level of the aortic below the renal vessels (Group A), the common iliac artery on both sides (Group B) and the hypogastric artery on the left side (Group C). Arterial obstruction was maintained in each group for 50, 40 and 25 days, respectively.In comparison with normal controls, the histological findings revealed discrete and diffuse interstitial hyalinosis with reducted elastic fibers, while dilated vascular lacunae were also present on TEM (Transmission Electron Microscope) and SEM (Scanning Electron Microscope) examination. The greatest ultrastructural damages were observed in the group with obstruction of the common iliac artery on both sides. The foregoing confirms that an eventual chronic obstruction of these arteries does not allow the formation of collateral vessels for the corpora cavernosa.