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Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years., Materials and Methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years., Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy., Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

Objective: Recurrence of urolithiasis is frequent. There are no reliable markers able to indicate recurrent stone former patients. Fetuin-A inhibits hydroxyapatite crystals formation and expansion. This study aims at evaluating whether serum fetuin-A may predict recurrent urolithiasis in young adults., Materials and Methods: This is a multicentre study. Young adults patients with recurrent urolithiasis attending 3 urology clinics were enrolled from July 2011 to December 2012. Inclusion criteria were: age 18-40 years, presence of more than one kidney stone. Exclusion criteria were: diabetes mellitus, metabolic disorders, obesity, hypertension, cardiovascular disease, infection diseases. Controls were participants without history of urolithiasis and currently undetected stones. Routine biochemistry, serum concentration of oxalate, fetuin-A, and parathyroid hormone (PTH) were assessed; 24/h urinary excretion of creatinine, uric acid, calcium, sodium, phosphorus, potassium, magnesium, glucose, oxalate, amylase, and protein was measured. Kidney ultrasonography and plain X-ray examination was performed., Results: The total cohort was represented by 120 young adults participants (90 patients, and 30 controls). Clinical characteristics were not different between patients and controls. No significant differences were found in serum concentrations as well as in 24/h urinary excretion of recorded variables. No significant difference was found in serum concentration of fetuin-A (median 35.1 ± 18.62 SD Vs 35.12 ± 14.12, μg/ml; p = 0,908)., Conclusions: The data of present study do not substantiate the hypothesis that serum fetuin-A may be a reliable predictor of recurrent urolithiasis in young adults.

Objectives: In chronic prostatitis there are many causes that may provoke a therapeutical failure of a systemic antibiotic treatment. At the moment a consensus has not been reached on the efficacy of the many therapeutical options that are available with not one of these approaches being efficacious in all patients. In our view the main causes of treatment failure are the well-known hurdle to antibiotic diffusion inside the glandular parenchyma associated with the so-called intraprostatic bacterial biofilms and the possible presence of local auto-immune reactions. Given this background, we tested ultrasound guided intraprostate infiltration of a cocktail of antibiotics and betamethasone, for a therapeutical options., Material and Methods: 320 patients, referred to us because of symptoms indicative of chronic prostatitis, were enrolled in this study. The inclusion criteria were the severity of the symptoms and the failure of repeated cycles of antibiotics in the previous 12 months. At the initial consultation patients completed the NIH Prostatitis Symptoms Index (NIH-CPSI). All underwent: a) digital rectal examination (DRE), b) transrectal prostatic ultrasound scan (TRUS), c) uroflowmetry, d) cultures of first voiding and after prostatic massage urine and cultures of sperm for saprophytic and pathogen germs, yeasts and protozoa, e) DNA amplification with polymerase chain reaction (PCR) on urine and sperm, for Chlamydia trachomatis, Mycoplasmas (Ureaplasma urealyticum and Mycoplasma hominis), Gonococcus, HPV and HCV Patients on the basis of laboratory results received a cocktail of antibiotics associated with betamethasone. The cocktail was administered as prostate infiltration. Administration was repeated after 7 and 14 days. Final assessment of the efficacy of therapy included not only the NIH-CPSI scores but also the patient's subjective judgement expressed as a "percentage overall improvement". The percentage judgements were arbitrarily divided into 4 classes: 0-30% no improvement (Class I); 30-50% satisfactory improvement (Class II); 50-80% good improvement (Class III; 80-100% cured (Class IV)., Results: Statistical analysis of the results showed 68% of patients were included in the Class IV and 13% were no responders (Class I)., Conclusions: In our opinion this is one of the more valid therapeutical approaches to chronic bacterial or abacterial prostatitis also if it requires more studies.

The adult kidney is studied using convex-array probes with a frequency of 3.5 MHz, whereas in children higher frequencies are advisable (5 MHz). The study of the organ may be carried out with three possible approaches (access routes): abdominal (anterior), lumbar (lateral), dorsal (posterior). For a correct and complete study of the renal echostructure 5 fundamental parameters need to be evaluated: shape, size, parenchymal echotexture, renal sinus and renal hilum. The most common anatomical variants need to be identified and namely, dromedary humps, foetal lobation, hypertrophied column of Berten, hypertrophied renal tubercles and labia. The use of colour-Doppler ultrasound equipment permits assessment of the main renal arteries, the segmentary branches at the level of the hilum, the interlobar arteries, the arcuate arteries, and the interlobular arteries (inconsistently). Colour and duplex ultrasound enable identification of flow signals from arteries that are not directly visible at B-mode sonography, since frequency resolution (related to the Doppler-shift) is greater than spatial and contrast resolution. Power doppler provides a detailed visualisation of the distribution of vascular structures and blood circulation in the different regions of the kidney parenchyma, affording a perfusion study similar to angiographic parenchymography. Unlike colour Doppler, power Doppler allows identification of the cortical circulation. The Doppler pattern of the renal arteries is typical of arteries with parenchyma destination, which show a systolic peak and a well-depicted diastolic curve due to low peripheral resistance. The parameters to be analysed are peak systolic velocity, acceleration time, pulsatility index, and resistive index.

Objectives: The echocolour and power-Doppler pattern of prostate carcinoma has not been precisely defined yet and no full agreement has been reached on this topic. This lack of certainty has repercussions on the decision to use echocolour and power Doppler in the diagnosis of prostate carcinoma and, most of all, in the guidance for prostate biopsy. The aim of this study is to assess the echocolour and power Doppler pattern in a series of patients with prostate carcinoma., Materials and Methods: 70 patients were studied with rectal exploration for suspected neoplasia and hypoechogenic areas at transrectal ultrasound. The following ultrasound guided biopsies resulted to be positive for adenocarcinoma with a Gleason score between 3 and 10., Results: In 40 cases (57.14%) perilesional vascularisation was found with no or limited intralesional colour signals. In 15 cases (21.4%) hypervascularisation was observed in the neoplastic areas (>3 intralesional colour signals). Fifteen cases (21.4%) showed hypovascularisation of the neoplastic areas or, at least, no vascular alterations were highlighted. In the largest forms (>21 mm) a 34.4% incidence of hypervascularised forms was found. No significant correlation was found between echocolour Doppler patterns and the histological Gleason score on neoplasias., Conclusions: The results of our study agree with the data of the literature on the prevalence of prostate neoplasias with perilesional vascularisation. Since no significantly indicative diagnostic pattern has been found, at present we feel that echocolour and power Doppler do not significantly contribute to the diagnosis of prostate neoplasia or the guidance for bioptic samplings.

Objective: Accurate staging of prostatic cancer is important for planning an optimal treatment, such as radical prostatectomy in clinical stage T2. About 40-50% of patients operated for cT2 disease show a pathological stage T3 disease. In a prospective study we analysed accuracy of TRUS and endocoil MRI in a group of patients before radical prostatectomy., Materials and Methods: 33 consecutive patients suspicious of prostate neoplasms were studied and staged with TRUS and endocoil MRI before prostatic biopsy and before radical prostatectomy. One urologist trained in TRUS conducted the exam, while one radiologist interpreted the MRI studies in a blind mode. The criteria evaluated were accuracy of global staging, extracapsular extension (ECE) and seminal vesicle invasion (SVI). These results were correlated with the histopathological findings after radical prostatectomy., Results: The histopathological results showed 14 patients (42%) with pT2 disease, 18 patients (54%) with pT3 disease and 1 case (4%) of pT4 disease. TRUS showed a low sensitivity (38%) and a good specificity (78%), with an overall accuracy of 50%; the best result was 96% specificity for SVI. Endocoil MRI showed a good sensitivity (70%) and specificity (76%), with an overall accuracy of 73%. Endocoilc was also useful to stage T1c disease when TRUS is negative. TRUS tends to understage, whereas endocoil MRI over-stages prostate cancer., Conclusions: TRUS and endocoil MRI may help in decision making about the appropriate treatment of prostatic cancer, even if they have limited current value, due to understaging or overstaging.

The obstruction of the pielo-ureteral junction, in most of the cases, recognizes an intrinsic etiopathogenesis, the presence of a segment ureteral aperistaltic and alteration of the ureteral musculature. The association of GPU stenosis and the presence of vascular anomalous shanks are frequent. The knowledge of this anatomical situation is important for choosing the therapeutic strategy and the surgical technique. The pre-operative diagnosis of the anomalous vase could condition the choice of the technique (endoscopic technique, laparoscopic), opting for open surgery to have a better control of the vascular shank. We have examined the use of the echo-color Doppler to diagnose the presence of anomalous vase. We have studied 13 patients (6 men and 7 women) between 18 and 62 years of age (average 35 years); the side interested by the obstruction was in 8 cases the right and in 5 cases the left. During surgery in 4 cases out of 13 examined anomalous vases were present. The pre-operative color Doppler found 3 anomalous shanks with a negative false, a positive false and 8 negative trues, showing a sensibility of 75%, a specificity of 88% with a global diagnostic ability of the 84%. We therefore believe that the echo-color Doppler is reliable enough in the pre-operative diagnosis of vascular anomalies associated to stenosis of the GPU and that could be used for pre-operative diagnosis of this urological affection.

The ultrasound study of bladder neck and urethral sphincter in men could be performed by means of transrectal ultrasound scan in longitudinal scanning or by probing the surface in transperineal scanning. The endocavitary ultrasound scan study gives the best indications in the evaluation of the bladder neck in men. The neuromuscular bladder dysfunctions' (neurologic bladder), which can be studied by ultrasound scan are dyssinergia, striped detrusor, detrusor-bladder-neck dyssinergia, detrusorial iper-reflexy bladder instability. In paraplegic subjects the exam should be performed in gynecological position or in side decubitus, and micturition is obtained by means of sovrapubic percussion and compression or with prevailing action of the abdominal press. The detrusor-striped dyssinergia is the dysfunction of the bladder where the ultrasound scan results are more meaningful and give the best elements. In these cases, already in basal conditions, could be present a bladder neck half-opened. During micturition there is an ample opening of the bladder neck and of the prostatic urethra, but scarce relaxation of the membranous urethra; sometimes a protrusion of the back lip of the bladder neck could be present too. In iper-reflexy (unstable bladders) and in detrusorial ipo-reflexy, ultrasound scans could result poorly specific and non-significative.

The high number of diagnostic methods for images (ultrasound, computer tomography--CT, magnetic nuclear resonance--MNR) has allowed the urologist diagnosis more precocious of renal masses contributing to increase the survival rate and quality of life of patients affected by renal carcinoma. Although many are the advantages that the ultrasound scan gives to the urologist, still today in presence of ultrasound scan results showing expansive renal masses, probably malignant, many perform a CT or MNR for diagnostic confirmation and tumor extension.

Both prophylaxis and stone-free status after ESWL are most important goals in treating urinary stone disease, because his high social cost. In order to this situation, we matched two homogeneous groups of patients that underwent ESWL because renal stones: during a one year follow-up with several US controls, daily 1.5 litres of low mineral content water was drank by I group patients; vice versa, daily 3 litres (1st ten days) and afterwards 2 litres of Rocchetta low mineral content water was drank by II group patients. This last kind of approach led to a significant improvement in stone fragments elimination time, in inferior calix stone cure and in stone recurrences rate. So we conclude that hyperhydration using right low mineral content water, is a simple and cheap way to improve both treatment and prophylaxis of urinary stones.

The abdominal and transrectal ultrasound is of a great importance in the follow-up and in the early postoperatory control in the patients which have undergone a radical prostatectomy. The abdominal ultrasonography can be used to identify the presence of abdominal or pelvic fluid collections in the postoperative period or to evaluating the upper urinary tract. Ultrasonography has come to play a primary role in the detection of lymphonodal and/or parenchymal metastasis. Transrectal ultrasound permits to identify the local illness relapse, whereas the ultrasonography examination during micturition allows the functional study of the bladder neck. Moreover, transrectal ultrasound is useful in guiding biopsy needle into a specific lesion seen on the sonogram in the perianastomotic region whereas random ecoguided biopsy in the perianastomotic area is necessary in patients with signs of recurrent cancer even in the absence of suspicious areas.

"Milk of calcium renal stone" (liquid renal calculosis) is a quite uncommon lithiasis distinguished by the presence of a semiliquid suspension of calcium salts or a "seed-like" sediment in a caliceal diverticulum or an ectasia segment of the collecting system. We reviewed 5 patients (1 male and 4 females, mean age 48.6 years), with a history of urinary tract infection, renal pain or haematuria. All patients underwent renal ultrasonographic assessment in both clinostatic and orthostatic position. Three patients underwent intravenous pyelography before ultrasound. Ultrasonography showed a sonolucent "levelled" image with a posterior acoustic shadow inside a hydro-caliceal dilation (2 pts.) or caliceal diverticulum (3 pts.); the persistence of the "level" in both clinostatic and orthostatic position allowed an immediate diagnosis in all patients. Intravenous pyelography performed before renal ultrasound showed no abnormality in 1 patient and was misleading in two; it otherwise confirmed the diagnosis when performed after renal ultrasonography. Three patients underwent surgery, two patients refused therapy; sonographic follow-up showed no evolution of the morphologic picture. Once considered as exceptional, liquid renal calculosis still remains rare pathology and accounts for 0.6% of all the urinary lithiasis diagnosed by ultrasound in our series. An accurate sonographic assessment allows a reliable diagnosis of this particular lithiasis and an easy discrimination from solid lithiasis, nephrocalcinosis, medullary sponge kidney and hydropyonephrosis. Hence, a correct diagnosis of this rare condition lets uneffective and improper treatments be avoided.

The authors describe the ultrasonic images they obtained in the follow up of three groups of patients who were divided according to basic pathology and treated with Nd: Yag Laser with contact (CLAP) and side firing (VLAP) fibers. Next the great differences noted between the results achieved with ultrasonic investigation and those obtained with flowmeter controls and IPSS are presented. The authors discuss the possible causes of these dissonances and hypothesize a new way to evaluate cervico-urethral de-obstruction: no longer an anatomical technique but a functional one.

Regarding the difficulty in using a common and standardised language in the diagnosis of Stress Urinary Incontinence (SUI) the authors developed a research protocol based on anamnestic, clinical, urodynamic and imaging forms, in order to have a numerous elements for the evaluation of this pathology. The preliminary study had to identify the most meaningful and common parameters, encoded according to broadly approved literature or the classification proposed by International Continence Society (ICS). One of the fundamental purposes was to clarify the role of ultrasonography technique applied to the field of Stress Incontinence. In this article the authors explain the choices they make, the technique employed for such a study and the ultrasonic images that are pathognomonic of the specific anatomo-functional disorders.

Percutaneous echoguided drainage of retroperitoneal collections is to be considered a recommendable technique which guarantees a good percentage of success and a complete resolution of the effusions and also gives a low percentage of complications. The drainage can be made through a simple percutaneous needle puncture or through a catheter which is kept for some days. The latter technique done by Seldinger or Trocar's method, guarantees more possibilities of success. The systemic echographic control during the post-operatory period of the urological patients have permit to find out the high frequency of small fluid effusions (haematic, urinary or lymphatic) in the operation area; not all the collections need a treatment. The urinary collections or those with clinical signs of anemia have to be drained. In the presence of small haematic or lymphatic collections, the ultrasonography follow-up shows almost always a progressive volume reduction with a following disappearance. Percutaneous drainage has to be performed in the presence of a large collection (more than 5 cm of diameter), in the case of a persistent collection or when patient presents with clinical features of infection.

Management of prostate cancer requires considerable economic and social efforts and may causes some discomfort to patient. To attempt a simplification of the prostate cancer follow-up (dosage of PSA, ultrasound and abdominal and pelvic TC and/or RM, bone scan, X-ray chest and X-ray bone), Authors have review the patients with prostatic cancer who were undergone to a conservative treatment with hormonal and/or radiation therapy. From January 1984 to September 1995, 136 patients have been evaluated in the Urological Department of University of Perugia. Local staging cancer has been made according to TNM system. Ultrasound transrectal follow-up study (TRUS) we made through longitudinal and/or transversal scans. The echographic features have been evaluated are the prostate size, volume and echogenic pattern of cancer, extracapsular extention and, finally, the echographic appearance of surrounding tissues (seminal vesicles, rectum, bladder). In 116 patients (85.3%) Authors found a good correlation of clinical course and the results of the investigations whereas in 20 patients (14.7%) such correlation falls to be demonstrated. Although PSA level remains an important prognostic marker for monitoring patients with prostatic cancer, TRUS is useful to determinate not only the local status but also to predict the subsequent clinical course of these patients. The later could be performed at least twice a year whereas further investigations could be prescribed only in presence of clinical suspicious of metastasis. It can be concluded that TRUS and PSA levels are sufficiently safe indexes on follow-up of prostate cancer which can replace the most expensive examinations avoiding an unnecessary cost to the health care system. Furthermore TRUS can recognize patients with urine flow obstruction who may benefit by treatment with improvement of their quality of life.

14 patients with primitive testicular cancer underwent US and afterwards surgery. A comparison between echo-pattern and hysto-pathology was done with the following results: sharp limits and ipoechoic homogeneous pattern in leydigioma and low-staging seminoma. Presence of anechoic areas and irregular limits: teratoma and embrionary carcinoma with no correlation with the staging. Inclusively no correlation between echo-pattern and staging of neoplasm or presence of neoplastic lymphnodes was observed.

From 1985 to 1993 we observed 9 female patients with urethral diverticula. All patients underwent first clinical examination and then US (suprapubic and transrectal or transvaginal scans) and X-ray cystography which demonstrated the communication between the diverticula and the urethra, MRI was also performed, in order to explain the rapports between the diverticulum and the sphyncter. All patients underwent surgery and 8 were cured. No cases of incontinence were observed.

Clinician questions in nephrovascular hypertension are: 1) Is hypertension secondary to nephrovascular disease? 2) Is vascular obstruction susceptible of surgical management? 3) Which is the best technical approach? In this review of recent international literature we have focused diagnostic value of echo-color Doppler in the screening of patients with secondary hypertension. The sensibility and specificity of this diagnostic test reach 89% and 99.5%. Respectively when the stenosis is over 70%. Anyway when the stenosis is under 70% the accuracy of this examination is lower. Angiography remains the gold standard test in patient eligible for surgery, although its invasiveness. Diagnostic tests of the renin-angiotensin axis (e.g. Captopril test) are useful too, but morphologic evidence is not provided. Surgical approach is the best choice in elective patients.

In a group of 115 patients with prostatic cancer, the correlation between the local and systemic evolution of the neoplasm has been evaluated. In 80 patients non local and systemic up-staging of the tumor was observed. In further 18 patients both local and systemic staging uppers and in the remaining 17 patients no correlation between local and systemic evolution was observed. In conclusion, in this series, the prostatic cancer demonstrated an high concordance in both local and systemic evolution and then the modifications of local staging can be used as a predictive parameter of systemic evolution of the prostatic cancer.

Clinical investigation is still fundamental in the diagnosis of La Peyronie's disease. In this study 36 patients underwent clinical investigation and ultrasound in basal conditions and during drug-induced erection, and the results were compared. In basal condition US does not provide much useful supplementary informations. During drug-induced erection US accurately visualizes plaque site and dimensions and anatomical abnormalities about corpora cavernosa, albuginea, septum and dorsal vessels.

US in the lower urinary tract usually explores the bladder and the prostatic urethra. In this study we used US instead of x-rays to visualize the remaining urethra in 42 patients. US was useful in the presence of urethral trauma. The site and extent of injury, particularly peri-urethral lesions (hematomas, urinary collection and abscesses in relation to the urethra) were observed. Ultrasound's efficacy and reproducibility were also useful in post-operative follow-ups.

Study with the Doppler method has been associated with "cavernometrics" and "cavernography" in erection pathologies for some time. But this enquiry is burdened not only be technical inaccuracies such as the lack of knowledge of the angle of incidence of the doppler wave and the diameter of the explored vessel etc, but also by intrinsic difficulty method itself. Therefore, the authors have used a color Doppler to individuate and study the cavernous arteries, and present the results obtained from a group of 21 patients, all affected by erectile deficits, who were selected on the basis of anamnestica and clinical criteria. They individualized 21 patients in whom the vasculogenic nature of their affection appeared probable, out of the 125 who were under their observation for their sexual inadequacy. In three patients the clinical suspicion of a venous incompetency was confirmed by dynamic "cavernometrics with cavernography". The study of the four phases of erection (flaccidity, tumescence, erection, detumescence) was carried out after an intracavernous injection of 20 micrograms of PGE/1. The parameters considered were: systolic velocity of the hematic wave, diastolic speed, the index of resistance and range. In cases of vasculogenic impotence with an arterial base the systolic wave in the 2nd and 3rd phases presented a speed inferior to the norm of standard values, the resistance index altered by the lacking of physiological increment due in the erectile beyond the closing of venous "polsters", also to the rigidity of the albuginea.(ABSTRACT TRUNCATED AT 250 WORDS)