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Introduction: We assessed clinical and urodynamic effects of solifenacin versus mirabegron in women with overactive bladder (OAB) syndrome. Material and Methods: Eighty women with OAB were randomized into 2 groups. In group A, the patients received solifenacin 5 mg once a day for 12 weeks; in group B, the patients received mirabegron 50 mg once a day for 12 weeks. Symptoms were assessed with OAB Symptom Score (OABSS). Patients underwent urodynamic investigation with pressure flow study. OABSS and urodynamic study were performed before and after treatment. Results: Both solifenacin and mirabegron were effective in improving OAB symptoms. Mirabegron showed greater tolerability with fewer patients discontinuing therapy because of side effects. Both solifenacin and mirabegron were effective in improving the storage function in the pressure flow study, but solifenacin showed a significant reduction of the detrusor pressure in the voiding phase with an increase in the postvoid residual urine volume. Conclusions: Mirabegron has shown to be a drug with the better balance between efficacy and tolerability in women with OAB.

To assess the relationship between uterine myomas, urinary symptoms, and urodynamic findings.A total of 49 women hospitalized for uterine myoma were eval- uated in this prospective study. Patients underwent- a detailed clinical evaluation and ukodynamic study. Uri- nary symptoms were as- sessed using 3-day micturi- tion diary and Patient Perception of Intensity of Urgency scale questionnaire. The dimensions of fibroma- tous uterus and single large myomas were evaluated by both transabdominal and transvaginal ultrasound. Urodynamic parameters and urinary symptoms were assessed before and 4 months after surgery.A total of 44 patients were evaluable at the end of the study: 32 out of 44 (72.8%) had urinary symptoms; 26 women underwent hysterectomy, and 18 had abdominal myomectomy. After surgery 87.5% of women were asymptomatic or showed improvement in urinary symptoms. Improvements were also seen in urodynamic parameters.Uterine myomas often result in uri- nary symptoms. Surgical therapy can result in signifi- cant improvements in symptoms as well as urodynamic findings.

Purpose To assess effectiveness and durability of Solifenacin (SS) versus tibial nerve stimulation (PTNS) versus combination therapy (PTNS + SS) in women with overactive bladder syndrome (OAB). Materials and Methods 105 women with OAB were divided randomly into three groups of 35 patients each. In group A women received SS, in group B women underwent PTNS, in group C women underwent combination of PTNS + SS. Improvements in OAB symptoms were assessed with OABSS questionnaire; patients’ quality of life was assessed with OAB-q SF questionnaire. Evaluation of effectiveness of treatments was performed with PGI-I questionnaire. OABSS and PGI-I were also assessed monthly for ten months. Results All treatments were effective on symptoms. PTNS showed a greater effectiveness than SS, but PTNS + SS was more effective than SS and PTNS. Furthermore, PTNS + SS showed a greater duration of effectiveness than PTNS and SS. Conclusions Combination of PTNS with SS showed more effectiveness and more durability than PTNS and SS alone.

Introduction This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). Materials and Methods 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. Results A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. Conclusion This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS.

Introduction: To assess the effectiveness of polyacrylamide hydrogel (Bulkamid ®) in injection therapy for urinary incontinence in women of 80 or more years. Materials and Methods: Twenty consecutive women mean age 84.5 (range 80-87) with stress or mixed urinary incontinence were enrolled in this prospective study. All subjects were evaluated at baseline and re-evaluated 7 days, 6,12,18 and 24 months after treatment. A detailed clinical evaluation, physical examination, daily pad count, urodynamic investigation and evaluation of urethral mobility by trans-labial ultrasound were performed. Results: A statistically significant decrease in the number of pads was observed in the follow-up (p = 0.0002 after 24 months). Physical examination showed a statistically significant lack or reduced lost of urine with stress test (p = 0.0163 after 24 months). Urodynamic findings showed an increase of Valsalva leak point pressure, maximum urethral closure pressure and functional length. Maximum flow and post void residual were respectively observed to be significantly reduced and increased only after 7 days from injection therapy. Quality of life (QoL) assessed with the Incontinence Impact questionnaire short form (IIQ-7) showed a statistically significant improvement (p = 0.0001 after 24 months). Patient satisfaction assessed with the Visual Analogue Scale and Patient Global Impression of Improvement questionnaire respectively produced evaluation of “satisfied” and “much improved” even after 24 months. Conclusions: Polyacrylamide hydrogel (Bulkamid®) is an effective treatment with low morbility in patients of 80 or more years.

Introduction: To assess efficacy and tolerability of a new complementary and alternative medicine (CAM) consisting of vitamins (C and D), herbal products (cucurbita maxima, capsicum annum, polygonum capsicatum) and amino acid L-Glutammina, in the treatment of female Overactive Bladder syndrome (OAB). Materials and methods: 90 consecutive women with OAB symptoms were enrolled in this prospective, randomized, controlled study. Women were divided randomly into two groups of 45 patients each. In group A, women received Solifenacin Succinate (SS), 5 mg. once a day for 12 weeks. In group B, women received CAM, 930 mg, twice daily for 12 weeks. Women were assessed with 3-day micturition diary, Patient Perception of Intensity of Urgency Scale (PPIUS), Overactive Bladder questionnaire Short Form (OAB-q SF) and Patient Global Impression of Improvement questionnaire (PGI-I). Results: 8 patients in group A and 1 patient in group B dropped out from therapy because of side effects. A reduction in the number of daily micturitions, nocturia and episodes of urge incontinence was present with both SS and CAM with statistically highly significant differences, but CAM was significantly more effective than SS. PPIUS and OAB-q SF showed improvements with both SS and CAM with a more significant efficacy of CAM. PGI-I, demonstrated improvements in the two groups of patients with a greater satisfaction expressed by patients treated with CAM. Conclusions: the small number of patients does not permit definitive conclusions; however, the results of the research showed the greater effectiveness and tolerability of CAM.

Introduction: The study evaluates the impact of three different sized (4.5-, 6- and 7-Fr) catheters on pressure-flow studies in women undergoing urodynamic evaluation for lower urinary tract symptoms. Material and Methods: 60 women referred for the evaluation of lower urinary tract symptoms were enrolled in this randomized controlled study. Patients were divided into two groups (A and B) of 30 women each. The patients underwent non-invasive free-flow uroflowmetry with determination of post-void residual urine volume (PVR) and two consecutive pressure-flow studies using two different transurethral catheters. In group A the two consecutive pressure-flow studies were performed using a 4.5-Fr catheter once and a 6-Fr catheter once; in group B the two consecutive pressure-flow studies were performed using a 4.5-Fr catheter once and a 7-Fr catheter once. Patients were also randomized for the consecutive order in which the two different transurethral catheters were used. Results: The pressure-flow parameters were significantly different from the equivalent free-flow findings. The maximum and average flow rate in all pressure-flow studies performed were significantly lower than the equivalent free-flow parameters and the flow time was significantly longer for all pressure-flow versus free-flow studies. Furthermore, there was a significantly larger PVR for pressure-flow than for free-flow measurements. There was no significant difference in maximum flow rate, average flow rate and flow time between 4.5- and 6-Fr pressure-flow studies (group A). However, there was a statistically significant difference between 4.5- and 7-Fr pressure-flow studies (group B) in those uroflowmetry parameters. Detrusor pressure at maximum flow (Pdet.Qmax) and maximum detrusor pressure (Pdet. max) in group A did not show statistically significant differences between 4.5- and 6-Fr pressure-flow studies whereas in group B Pdet.Qmax and Pdet. max were significantly different between 4.5- and 7-Fr pressure-flow studies. Conclusions: A 4.5-, 6- or 7-Fr transurethral catheter may obstruct micturition changing uroflowmetry parameters. A statistically significant difference was found in all but PVR parameters particularly in all detrusor parameters between 4.5- vs. 7-Fr whereas no statistically significant difference was found in all but PVR parameters between 4.5- vs. 6-Fr. We can thus state that pressure-flow findings may be influenced by different sized transurethral catheters. A misinterpretation of pressure-flow findings may have clinical implications on establishing an accurate diagnosis.

Obiective: To assess the degree of satisfaction of women undergoing surgical repair of prolapse, compared with the clinical and urodynamic findings. Materials and Methods: 72 women hospitalized for pelvic organ prolapse (POP) were enrolled in this prospective study. Patients underwent clinical evaluation and urodynamic study before and 4 months after POP repair. Women were assessed for urinary symptoms by micturition diary and patient perception of intensity of urgency scale. Women were also questioned about defecation and sexual life. POP repair was performed in all cases without the use of a mesh. Subjective evaluation was performed by patient global impression of improvement questionnaire. Results: 56 women were evaluable. Improvements were found in all micturition symptoms and in particular in voiding symptoms. Feeling of vaginal bulging disappeared in all patients. A slight improvement was found in constipation; 62% of patients had a normal sexual life but 27% refrained from sexual activity. Judgement of patients was between “much improved” and “very much improved”. Conclusions: Disappearance of the feeling of vaginal bulging was by far the best result. Improvements were found in most of the symptoms particularly in voiding symptoms and urodynamic findings.

Overactive bladder syndrome (OAB) is a chronic disease, the prevalence in the general population is reported to be 14-16%. Anti-muscarinic agents are considered the first-line pharmacological treatment for the management of OAB; although a long lasting therapy is indicated to reach a better control of OAB symptoms an high percentage of patients discontinue the cure after a brief period. Our attempt is to investigate whether the cost of solifenacin succinate may influence the long lasting regimen and patients' drug efficacy.70 consecutive women, with symptoms of OAB were enrolled in this randomized controlled study. In group A, all patients received solifenacin 5 mg by the urologist, without any cost; they were instructed to get the drug once daily for 4 months, differently, in group B, patients need to buy the drug which was administered as in the group A. Frequency, nocturia, incontinence, voided volume, were evaluated by a 3-day micturition diary. Overactive Bladder Questionnaire Short Form (OAB-qSF) was used to assess the impact of OAB symptoms on patients' quality of life (QoL). Urgency was assessed by patient's perception of intensity of urgency scale (PPIUS). Micturition-diary, OAB-qSF, PPIUS, were completed at baseline and after four months.A greater number of patients discontinued solifenacin in the group B who need to buy the drug. We observed significant differences in groups A and B in relation to frequency, nocturia, urge incontinence and voided volume comparing the pre and post treatment symptoms. The patients' perceptions of intensity of urgency and the PGI-I scale showed a significant improvement greater in group A in respect with group B.The cost of anticholinergic may be responsible for both early discontinuation of treatment and incomplete adherence to therapy with unsatisfactory results on symptoms and an incorrect assessment of the effectiveness of the drug by the urologist.

Aims: This study compared the effectiveness of solifenacin succinate (SS) versus percutaneous tibial nerve stimulation (PTNS) in women with overactive bladder syndrome (OABS). Methods: A randomized controlled crossover study of 40 women with OABS was performed. Patients were randomized into two groups. In group A, patients received SS and then PTNS. In group B, patients underwent PTNS and then SS. Voiding diaries, quality of life surveys and patient perception of intensity of urgency questionnaire were performed before and after each treatment. The global impression of improvement questionnaire was performed at the end of the study. Results: A reduction in the number of daily micturitions, episodes of nocturia and urge incontinence were found with both SS and PTNS in all groups, but PTNS showed a greater effectiveness than SS. There was an increase in voided volume in all groups with both SS and PTNS, but patients treated with PTNS had a greater increase. PTNS showed greater effectiveness in patient perception of urgency and quality of life. Conclusion: This study demonstrates the effectiveness of SS and PTNS In women with overactive bladder symptoms. However, greater improvements were found with PTNS.

This study was performed to assess the feasibility and possible advantages of bowel sonography after fluid filling of intestinal loops compared with conventional sonography. Forty-five consecutive patients with known or suspected coeliac disease (35 females, ten males; age range 11–65 years) prospectively underwent sonography before and after ingestion of 750 ml of an aqueous solution of polyethylene glycol. Results before and after fluid distension were compared to assess whether luminal filling improved small-bowel visualisation. Luminal filling improved visualisation of intestinal features (luminal diameter, mucosal folds, parietal layers) in 77.6% of cases (marked, moderate or mild improvement in 2, 16 and 17 patients; 4.4%, 35.5% and 37.7%), respectively, and showed no change or worsening in 20% and 2.2% nine and one patient), respectively. Baseline examination showed abnormal features in 13/25 celiac patients (dilated fluid-filled loops, increased peristalsis, transient intussusception, mesenteric lymph nodes, intraperitoneal fluid). Reexamination after luminal filling showed additional abnormalities in six of the previous 13 and in three further coeliac patients. There were no false positive signs due to fluid administration. Luminal filling can improve visualisation of bowel walls and fold pattern and may be helpful in selected cases.

The aim of the study was to evaluate, in a group of female patients with urinary incontinence (UI), the effect of aging on: a) urodynamic findings; b) incidence of detrusor overactivity; c) types of urinary incontinence; d) pelvic organ prolapse; e) body mass index; f) anorectal disorders.Eighty four consecutive patients with urinary incontinence were enrolled in this study. Patients were divided into two groups according to their age: group A: patients with ageor = 65 years, group B: patients with age65 years. Patients underwent a full urogynaecological workup with a clinical evaluation and urodynamic study.In older patients urge and mixed urinary incontinence were the most prevalent type of (UI). In these patients an increase of the bladder sensation with a decrease of the bladder capacity, an increase of detrusor overactivity and a reduction of the maximum urethral closure pressure were found. Furthermore, a higher body mass index was observed in older patients.The results of this study show an age-associated correlation of types of urinary incontinence, urodynamic findings, body mass index and incidence of detrusor overactivity.

A prospective study was conducted on 62 female patients with overactive bladder syndrome, to check for differences in clinical profiles, subjective symptoms and urodynamic findings, between patients with or without cystometric evidence of detrusor overactivity (DO). Later both groups of women were assessed for the effect of an antimuscarinic agent, solifenacin succinate (SS), on the considered parameters.Each patient underwent a full history, a physical examination, urinalysis and a urodynamic study. Provocative manoeuvres - cough, postural changes - were used when the cystometric study was performed. Hence two groups of patients were formed, divided according to the presence or absence of DO at the cystometric study: patients with overactive bladder syndrome (OAB) with DO (29), patients with OAB without DO (33). The two groups were compared before and after treatment with SS.When we compared the two groups, before treatment with SS, we saw statistically significant differences in just a few of the parameters assessed in the clinical profiles: patients with DO had a higher rate of constipation; whereas patients without DO had a higher rate of stress incontinence and a larger number of deliveries. Following treatment with SS, in both groups, significant differences were shown in subjective symptoms and urodynamic findings, with a reduction of the numbers of voids and incontinence episodes and an improved urge score. A significant increase in bladder capacity during the cystometric study was shown only in patients with DO. Whereas no statistically significant improvement was shown in patients without DO. Treatment with SS was connected with delayed involuntary detrusor contractions during cystometry and a reduction of their number and amplitude. Finally, SS did not produce any significant negative effects on detrusor function during voiding.The findings of this study suggest that it is important to conduct a urodynamic study in patients with OAB, to check for DO. In our experience, treatment with SS was shown to be effective only in patients with involuntary detrusor contractions at the cystometric study.

The goal of our work is to demonstrate how, in the approach to laparoscopic radical prostatectomy, the ligation of Santorini?s dorsal venous complex is not necessary. The retrospective evaluation of video-laparoscopich radical prostatectomy performed at UOC of Jesi with this technical device, showed an increased blood loss compared to a technique that provides for the ligation of Santorini's plexus and, overall, reduced blood loss compared with the average radical open prostatectomy.50 video-laparoscopic extraperitoneal radical prostatectomies were evaluated, which were performed with the same technique and by the same operator. The technique involves the non-ligation of Santorini's venous plexus. Surgical, oncological, functional outcomes were considered and in particular blood loss.The results are consistent with those reported in literature, and without ligation of the Santorini's venous plexus , there has been no increase in blood loss intra-and / or post-operatively, or in the percentage of patients with hemotransfusion.The video-laparoscopic radical prostatectomy, although a not yet codified and standardized technique for the treatment of organ-confined prostate cancer, did show oncological and functional results basically l similar to open-sky technique. But compared to this, it has certainly demonstrated a lower blood loss and a reduction of morbidity. The non ligation of Santorini's venous plexus, always necessary during open prostatectomy, in our experience is not necessary in video-laparoscopy.

We referred our experience about ultrasound in the diagnosis of the acute urinary retention by mechanical obstruction in woman. We believe ultrasound has a very important role in imaging of the lower urinary tract because it simplicity and no jonizing radiation used. Anatomical pathologies of the bladder neck and urethra can be detected and documented in order to make the right therapy decision.

Parameatal urethral cysts are a rare pathology reported both in male and in female. The aethiology is not completely understood. Urography, urethroscopy and urethrography were described to diagnose parameatal urethral cysts. The treatment of choice is the complete excision of the cyst. A rare case of acute urinary retention in a 17-year-old woman by a parameatal urethral cyst is presented.

The aim of the study was to evaluate differences in urodynamic findings in women with urinary incontinence between subjects with or without intrinsic sphincter deficiency (ISD).Sixty consecutive female patients with a history and urodynamically confirmed diagnosis of pure urinary incontinence were evaluated. Patients were divided into two groups according to their abdominal Valsalva leak-point pressure (AVLPP) values using a cutoff of 60 cm H(2)O: group A patients with AVLPP/=60 cm H(2)O and group B patients with AVLPP60 cm H(2)O.Qmax and Qave in group A were higher than in group B; flow time was significantly shorter in group A than in group B. PVR in group A was lower than in group B. In pressure flow study, all detrusor findings in group A had a pressure value lower than in group B. MUCP in patients with AVLPP/=60 cm H(2)O was significantly lower than in group B, but the degrees of specificity and sensitivity in group A and B were 90% and 43.3%, respectively.The results of this study confirm a more efficient bladder emptying in patients with AVLPP/=60 cm H(2)O.

Objectives: The aim of this study was to evaluate the importance of a) urethral and/or vaginal infections caused by common germs or Mycoplasmas, Chlamydia, Candida; b) age of patients; c) pelvic floor disorders in the development of irritative urinary symptoms in women. Methods: 77 consecutive abacteriuric symptomatic female patients were compared with 55 asymptomatic women. A detailed micturition history and a genitourinary physical examination were performed. Urine samples as well as vaginal and urethral swabs were taken for cultures. Results: No statistical difference was found between the two groups regarding both urethral and/or vaginal infections and pelvic floor disorders. Whereas a significant statistical difference was found in the age of the patients. In the symptomatic group the women were older than in the asymptomatic group. Conclusions: The results of this study confirm that ageing is a very important cause in the development of the lower urinary tract symptoms in women.

The aim of our prospective study was to evaluate the diagnostic accuracy of MR Enteroclysis (MRE) to assess the extension and complications of Crohn's Disease (CD) in comparison with conventional enteroclysis (CE).The study comprised 30 consecutive patients affected by Crohn's disease (18 women and 12 men; age range 16-76, mean age 40.6 years), who underwent conventional and MR enteroclysis. The MR enteroclysis protocol includes three sequences: coronal and axial FIESTA and ssFSE sequences and T1-3D-FSPGR sequences before and after intravenous injection of gadolinium, acquired after administration of 1.6-2 l of iso-osmolar polyethylene glycol solution via a nasojejunal catheter. Two radiologists blindly scored each sequence for opacification of the lumen, small bowel distension and image quality and evaluated the following parameters: presence of wall ulcers, pseudopolyps, stenoses and fistulae.The accuracy of the FIESTA sequence was significantly higher (p0.01) than the ssFSE and 3D FSPGR sequences in the evaluation of lumen opacification and bowel distension, and for the overall quality of the images (p0.01). The sensitivity and specificity of MRE were 82% and 100% for the visualisation of parietal ulcers, 87% and 100% for pseudopolyps, 100% and 88% for stenoses, 75% and 100% for parietal fistulae. High-grade stenoses with prestenotic dilation (n=6) and low-grade stenoses (n=9) were visualised both by MRE and CE. MRE also showed abscesses in two patients, not seen at CE. The FIESTA and ssFSE sequences had higher accuracy in the detection of wall ulcers and fistulae, whereas the 3D FSPGR sequences showed higher accuracy in the evaluation of wall thickening.MRE is able to demonstrate the spectrum of superficial, intramural and exoenteric alterations in Crohn's disease and closely correlates with CE in demonstrating alterations of the bowel lumen and wall.

Objective: To evaluate the relation between post-voiding residual urine (PVR) and urodynamic findings, voiding patterns, and the degree of prolapse in women with cystourethrocele. Patients and Methods: According to the average PVR value measured by means of catheterization after three separate and spontaneous micturitions, 73 women with minimal urethral hypermobility (n = 8) or colpocystocele (n = 65) were subdivided into 3 groups: group 1 = patients with a PVR of ≤50 ml; group 2 = patients with a PVR of >50 ml and ≤150 ml, and group 3 = patients with a PVR of >150 ml and ≤500 ml. The patients underwent a thorough physical examination, and prolapse was evaluated and graded. The women then underwent a complete urodynamic investigation. The 3 groups of patients were statistically correlated according to the urodynamic findings, voiding patterns and degree of prolapse. Results: A large PVR in women with cystourethrocele was often associated with poor maximum flow rate, intermittent flow and with the highest degree of prolapse. Conclusion: The present study suggests that uroflowmetry is a very simple, noninvasive, but also essential method of investigation in evaluating female patients with cystourethrocele, particularly when a large PVR is suspected.

To evaluate the usefulness of MRCP, before and after secretin administration, in diagnosing Santoriniceles in patients with pancreas divisum.One hundred and eight patients with suspected pancreatic disease, underwent dynamic magnetic resonance cholangiopancreatography (MRCP) before and after secretin administration (S-MRCP). S-MRCP images were evaluated for presence/absence of pancreas divisum, Santorinicele; size of the main pancreatic duct and of the Santorinicele. The onset of duodenal filling was calculated on dynamic S-MRCP images. S-MRCP findings were compared to endoscopic retrograde cholangiopancreatography (ERCP) ones (39/108).Pancreas divisum (PD) was detected in 6/108 patients (6%) at MRCP, and in 16/108 patients (14%) at S-MRCP. ERCP confirmed the diagnosis in 12/16 patients, with 1 false positive. 3 patients did not undergo ERCP. Santorinicele was detected in 4/108 (3%) patients at MRCP and in additional 4/108 (3%) patients at S-RMCP, only in patients with PD. Santoriniceles were confirmed in 7/8 patients at ERCP; in 1/8 patient CPRE was unsuccessful. The duct of Santorini was significantly larger (p0.05), in the pancreatic head, in patients with PD and Santorinicele (3.6 mm) compared to those with PD only (2.2 mm). A significant reduction in size of the pancreatic duct (26%) and of the Santorinicele (63%) was observed after sphincterotomy. The onset of duodenal filling was significantly delayed in patients with Santorinicele (2.1 vs 1.3 minutes)(p0.05).S-MRCP helps to identify patients with pancreas divisum and Santorinicele, a known cause of impeded pancreatic outflow which benefits from endoscopic treatment.

The case of repeated metastases of the bladder from renal cell carcinoma in a 59 year old male patient is presented. Two years after nephrectomy the ureteral stump and the bladder were interested by two different metastases. Afterwards, other nine metastases developed into the bladder during the following 12 months. Biopsy with coagulation were performed in any case. Bladder metastases ranged between 2 and 4 mm. No other metastasis was discovered by MRI and skeletal scintigraphy. Thirteen months after the first bladder metastasis, intracavitary Bacillus Calmette-Guerin was used. No report was found in the literature about BCG in the treatment of superficial bladder metastases from renal cell carcinoma. However 15 months from beginning of BCG treatment no metastasis developed from the bladder that now is disease-free after a follow-up of 19 months.

To evaluate the possible optimization of a well-tolerated and versatile method of intestinal preparation able to adequately free the lumen and consequently improve diagnostic results with a lower risk of prolonged hospital stay for incorrectly prepared patients.We examined 40 patients, namely 20 men (mean age 70 years, range 52-87) and 20 women (mean age 68 years, range 49-81) referred to the Institute of Radiology of the Università Cattolica del Sacro Cuore, Gastrointestinal tract Unit, to undergo double contrast colonic enema. The patients were divided into two groups by one-to-one randomization: group 1 was prepared with the conventional method and group 2 with the new protocol for intestinal preparation. On the two days before the examination a low-residue diet was administered; the day before the examination a phial of Fosfo-soda fleet was administered in two times (at 8 am and 4.30 pm), which was diluted with half a glass of water. Bread, pasta and vegetables were strictly forbidden at lunch and soup or milk at supper; the patients were fasted on the examination day. Two evaluations were performed: one to assess tolerance to the preparation and the other, a radiographic study, to assess the grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting.Of the 20 patients given X-prep, 3 had to discontinue it and 4 exhibited severe side-effects, but completed the treatment; tolerance was satisfactory in the remaining 13 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 9, 17 and 16 patients respectively. None of the patients given Fosfo-soda fleet had to discontinue it and tolerance was satisfactory in 19 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 15, 18 and 18 patients respectively. The statistical analysis of all data was performed with Wilcoxon test.Intestinal preparation with Fosfo-soda fleet appeared to be definitely better than the conventional method relative to tolerance (p = .02, a statistically significant difference), while providing similarly satisfactory data relative to the other parameters.Our results, coupled with the versatility of Fosfo-soda fleet (possible application in colonoscopy) and its ease of use recommend this preparation not only for inpatients but also for outpatients in whom self-administration is feasible.

The case of a 56 year-old male patient with asynchronous isolated metastases to the ureteral stump and bladder from renal cell carcinoma is presented. Ureteral metastasis was discovered 2 years after nephrectomy. Cystoscopy and MRI were performed. An excision of the ureteral stump with a cuff of bladder was carried out. No other metastasis was observed. Six months later a transurethral resection was performed on account of metastasis of the right wall of the bladder. Pathological examination demonstrated a renal cell carcinoma metastasis. After 6 months a new vesical metastasis from renal cell carcinoma was found. The small nodule of the lower part of the right wall of the bladder was removed. The literature is reviewed and the presentation, metastatic pathways, management of ureteral stump and bladder metastases from renal cell carcinoma are discussed.

When a complex reality as the Department of Diagnostic Imaging and its staff is aimed at the provision of a service, it may be extremely difficult to identify all present correlations and in turn, correlate them with the final goal. The relationship between human and technical resources, between organization and environment are of the utmost importance in planning the structure design. It should be kept in mind that "the person" is the pivot of any innovation for change. Participation by all members, a more flexible, structure, is required. In education and teaching, the global network we are heading for, could become the determining factor in a continuing training process and multispecialized research, facilitating the circulation of information in an interactive, formative dialogue.

It is well-known that while RIS allows the management of all input and output data of a Radiology service, PACS plays a major role in the management of all radiologic images. However, the two systems should be closely integrated: scheduling of a radiologic exam requires direct automated integration with the system of image management for retrieval of previous exams and storage of the exam just completed. A modern information system of integration of data and radiologic images should be based on an automated work flow management in al its components, being at the same time flexible and compatible with the ward organization to support and computerize each stage of the working process. Similarly, standard protocols (DICOM 3.0, HL7) defined for interfacing with the Diagnostic Imaging (D.I.) department and the other components of modules of a modern HIS, should be used. They ensure the system to be expandable and accessible to ensure share and integration of information with HIS, emergency service or wards. Correct RIS/PACS integration allows a marked improvement in the efficiency of a modern D.I. department with a positive impact on the daily activity, prompt availability of previous data and images with sophisticated handling of diagnostic images to enhance the reporting quality. The increased diffusion of internet and intranet technology predicts future developments still to be discovered.

One of the major and demanding problems in the management of a modern department of Radiology is undoubtedly the organization of a radiologic archive. Its management has been increasingly difficult in last years both for the increase in procedures and the number of radiologic exams. At the Radiology department of UCSC, since some years, this problem has been tackled. Major objectives have been identified in focusing on responsibilities, global management and planning of radiologic film retrieval and archiving integrated with health care activities (scheduling of admissions and exam appointments, reporting, discharge). Based on these assumptions, the archive has been divided into 3 sections, each dynamically integrated with the others. The 3 archives should be integrated with RIS and supported by information technology. RIS is considered the starting point of the process. In fact the system ensures communication to the archiving workstation and to the radiology room of patient admission and consequent execution of the exam which involves image production. This user-friendly procedure enables consistent information between RIS and archiving system and correct association of images to the patient medical report, for subsequent consultation.

Thirty-two female patients affected by urinary incontinence were enrolled for rehabilitative treatment (functional electro-stimulation by vaginal electrode performed three times a week for one month followed by biofeedback performed three times a week for one month). Complete clinical and urodynamic studies, urethrocystography in order to allow Blaivas and Olsson radiologic evaluation were performed. Echography of the bladder and urine cultures were done too. Patients with severe urogenital prolaxus and obesity, neurologic urinary disorders and surgery for incontinence, were excluded. The same patients were urodynamically reassessed at the end of the treatment and a detailed clinical evaluation was obtained from each patient. 78% of patients reported a considerable improvement in clinical symptoms and only 9% reported no improvement. Urodynamic findings showed an increase of maximum cystometric capacity in 6 patients, improvement of maximum urethral closure pressure and/or functional profile length in 17 patients. Disappearance or reduction of involuntary detrusor contractions were found in 2 out of 6 patients with unstable bladder.

Juvenile rheumatoid arthritis is a chronic disease, with the synovium as the target tissue. We made 594 US examinations of the knee in 240 children (mean age: 9 years) with juvenile rheumatoid arthritis. All patients underwent at least one US exam and 156 patients underwent many US examinations during 3 years' follow-up. In our series mean synovial thickness was 6 mm (range: 2.5-11 mm) while in normal subjects mean synovial thickness is 2.7 mm (range: 1-4.5 mm). The mean thickness of the suprapatellar bursa was 9 mm (range: 4-18 mm) versus 2.8 mm (range: 1-5 mm) in normal subjects. The mean length of the suprapatellar bursa was 27 mm (range: 13-44 mm) versus 14.3 mm (range: 8-23.5 mm) in normal children. Cartilage thickness was 3.3 mm (range: 1.2-5.8 mm) at the intercondylar notch, and 3 mm (range: 0.8-5.3 mm) at the femoral condyles. Cartilage thickness is 3.5 mm (range: 2-6 mm) at the intercondylar notch, and 3.2 mm (range: 1.8-5.4 mm) at the femoral condyles in normal subjects. The articular cartilage outline was blurred in 36% of patients with active knee involvement. A Baker cyst was found in 24 patients (10%). The mean volume was 3 ml (range: 1-40 ml). No tendinous alterations were observed. Changes in synovial membrane (synovial thickness), the presence of fluid in the suprapatellar bursa, and blurring of the articular cartilage outline showed statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. On the contrary, articular cartilage thickening or thinning showed no statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. In conclusion, US is a simple, rapid, inexpensive and accurate method for the staging and follow-up of joint inflammation in patients with juvenile rheumatoid arthritis of the knee.

A total of 60 patients with transitional cell carcinoma of the bladder G1-G2, pTa pT1 previously subjected to TUR, were randomised to receive Mitomycin-C (MMC) 30 mg for 12 months (A group) or Mitomycin-C 40 mg for 6 months (B group). The objective of this trial was to compare the prophylactic activity of MMC using two different dosages and treatments. All patients were evaluated with cystoscopy. Follow-up was of 24 months. The incidence of recurrence in the A group was 40% with a recurrence rate of 3.3. In the B group the incidence of recurrence was 27.6% with a recurrence rate of 2.2. One case of progression was present in the A group. The side effects were more frequent in the A group (37% vs 13.3%) and they were mainly due to chemocystitis. These data suggest that MMC 40 mg for 6 months appears to be superior to MMC 30 mg for 12 months in the prophylaxis of superficial bladder carcinoma.

Previous publications attempted to define normal and abnormal ranges in the measurement of pyloric length (L), breadth (D), muscle thickness (S), volume (V) and muscle index (MI). We examined with US 286 patients with suspected hypertrophic pyloric stenosis and investigated all the above diagnostic criteria. Normal and abnormal ranges were in agreement in all five measurements, though less apparent for pyloric volume and muscle index. The patients with borderline values were 46 (16%) for pyloric muscle thickness, 98 (34%) for breadth, 52 (18%) for length, but only 22 (7.7%) for pyloric volume and muscle index. Borderline patients received medical therapy with the antispasmodic drug metaclopramide hydrochloride and they were examined with US after 15 days. Only 8 of 22 borderline patients (36%) developed a typical hypertrophic pyloric stenosis. In the others, pyloric volume was reduced and the symptoms subsided. Pyloric parameters cannot be always measured accurately, but pyloric volume and muscle index measures better distinguish normal from abnormal findings. The formula for pyloric volume calculation is simpler than that for pyloric muscle index calculation and easier to memorize, also because no correction for body weight is necessary.

The oncocytic cell is an epithelial cell with granular eosinophilic cytoplasm extremely rich in mitochondria. It may be observed in different parenchymal tumors of the kidney: oncocytoma, granular cell carcinoma (oncocytic adenocarcinoma), clear cell adenocarcinoma. Renal oncocytoma, a benign tumor, is made up exclusively of regular oncocytic cells.In granular cell carcinoma (oncocytic adenocarcinoma), different aspects of malignancy are present as necrosis, cellular pleomorphism. In clear cell adenocarcinoma, on the contrary, it is possible to observe only some nests of oncocytic cells.The Authors underscore the presence of oncocytic cells in such different neoplasms and the possibility, especially in clear cell adenocarcinoma with nests of oncocytes, that needle biopsy or aspiration cytology from such an area can lead to a misdiagnosis.

Gastroesophageal reflux (GER) is a very common event in the pediatric patient. An accurate and atraumatic imaging technique must be used to differentiate normal from abnormal conditions. Sonography (US) appears to answer this purpose, as recently shown in the international literature. One hundred and seventy-eight patients with suspected GER were enrolled in this study; their age ranged 10 days to 15 years. They were examined with both US and barium swallow, in a double-blind trial. The patients were divided into three groups, according to GER severity, i.e., absent or physiologic GER, moderate GER and severe GER. We considered not only the number of reflux episodes, as related to patients' age, but also reflux volume, esophagus clearing time and possibly coexisting hiatal hernia or esophagitis. US and barium swallow results were in agreement in 93% of the cases. In the other cases US demonstrated more severe GER than barium meal. No statistically significant differences were observed in the various age groups. Since US is a relatively cost-effective, noninvasive and physiologic method which is widely available and uses no ionizing radiations, it can be recommended as the screening test of choice in symptomatic children and in the follow-up.

Unsuspected neoplastic disease of the ureteric stump was discovered in 4 of 47 patients (8.5%) undergoing cystectomy for bladder cancer between 1988 and 1990. Carcinoma in situ was found in one case; invasive cancer was present in 3 cases. Ureteric malignancy was found only in patients with undifferentiated bladder tumor or with a widespread involving of the upper tract of ureter and pelvis. No carcinoma in situ or tumor was discovered in the distal ureter in patients with localized transitional cell carcinoma of the bladder. This research emphasizes the low risk to constructing uretero-intestinal anastomosis with unsuspected tumor in the distal margin of ureter in patients with a transitional cell carcinoma of the bladder.

A retrospective review of 186 cases of transitional cell carcinoma of the bladder observed between 1987 and 1990 is described. Squamous metaplasia was present in 37 cases. This histological feature was especially found in association with poorly differentiated and invasive tumors: the presence of extensive areas of squamous metaplasia (metaplastic areas = or50% of neoplastic surface) was always found in association with high grade neoplasms. For these reasons the authors conclude that transitional cell carcinoma of the bladder showing squamous metaplasia is more aggressive than pure transitional cell carcinoma.

62 men with prostatic hypertrophy and bladder obstruction and 31 age matched women without lower urinary tract obstruction, underwent urodynamic testing which included uroflowmetry, gas cystometry, urethral pressure measurement: electromyography and pressure flow study was only performed to the patients with prostatic hypertrophy. No patient with neurological disease, diabetes mellitus, pelvic operation, neoplasm or stone of the bladder was admitted to the study. Involuntary detrusor contractions (unstable detrusor) were found in 74.2% of male patients and in 25.8% of female patients. In male patients aged over 72 the percentage was 81.8% while in the female patients of the same age was 60%. All the 62 male patients underwent prostatectomy. Two months after surgery, acystometry was done. Unstable detrusor was found in 63.1% of cases. Patients over 80 had a percentage of 100%. These data suggest obstructive prostatic hypertrophy as an important factor in development of involuntary bladder contractions, but the primary pathophysiological factor appears to be age of patients.

No. 54 patients with transitional cell carcinoma G1-2; pTa-pT1, were treated with intravesical therapy with Mitomycin C (MMC) (first group of 27 patients), and Interferon alfa 2a (IFN) (second group of 27 patients), following transurethral resection. The objective of this trial was to compare the prophylactic activity of these two drugs. All patients were evaluated with cystoscopy and urine cytology. Mean follow-up was for the first group of patients (MMC) of 10.4 months, for the second group (IFN) of 12 months. The incidence of recurrence in the first group (MMC) was 11.1% with a recurrence rate of 2.1. In the second group (IFN) the incidence of recurrence was 51.9% with a recurrence rate of 7.4. No case of progression evaluated by grade and stage was observed. The side-effects were more frequent in the MMC group and they were mainly due to chemocystitis. These data suggest that MMC appears to be superior to IFN in intravesical therapy of superficial bladder carcinoma.

A case of leiomyosarcoma arising from the wall of arterious renal vessel is described. While the origin of this neoplasm from the smooth muscle cells of the capsule, blood vessels or the pelvis of the kidney is well known, it is rarely possible to demonstrate the site of origin.

The author studied all of the 1361 male patients that had been hospitalized from December 1986 to September 1990 for chronic urinary retention to determine the incidence of urothelial tumor of the bladder. Sixty-nine (5.07%) were found to have primary urothelial carcinoma of the bladder. However, in another study group comprised of 433 males over 55 with no problems of obstruction, 0.23% had a bladder tumor. This study underscores the role of urinary stasis in the development of urothelial carcinoma of the bladder.

During the period 1988-1990, 683 patients with diagnosis of benign prostatic hyperplasia underwent transvesical prostatectomy. The purpose of the study was to establish the possible presence of incidental carcinoma of the prostate (ICP). Prostatic tissue was studied with sections taken every 0.5 cm. The incidence of ICP was 12.00%. The mean age of patients was 73.5 years. 60.98% of tumors classified T1a, 39.02% T1b. No case of G3 tumor was observed while 92.68% of neoplasms was classified G1 and 7.32% G2. 74.95% of tumoral nests into the prostatic tissue had a breadth about one millimetre.

The Authors report a retrospective review of 224 cases of transitional cell carcinoma of the bladder observed between 1986 and 1990. Squamous metaplasia was present in 45 case. This histological feature was found especially in association with poorly differentiated and invasive tumours: the presence of extensive areas of squamous metaplasia (metaplastic areas = or greater than 50% of neoplastic surface) was always found in association with high grade neoplasms and with a disease-free period shorter than transitional cell carcinoma. The Authors conclude that squamous metaplasia in transitional cell carcinoma of the bladder is a really unfavourable prognostic factor.

The Author presents a case of primary signet-ring cell carcinoma of the urinary bladder treated with radical cystectomy and died 17 months after surgery. Only 14 well documented cases have been previously published. Biological and clinical aspects of the neoplasm and its therapy are discussed too.

The Authors report their personal experience of pure squamous cell carcinoma of the bladder. Between 1984 and 1988 they have observed 389 tumors of the bladder; squamous cell carcinoma was present in fifteen cases (3.8%). Epidemiology, pathology (gross configuration of tumor, histologic grading, staging according to the criteria of the UICC of 1987), presenting symptoms, treatment and survival have been considered. The Authors underline the importance of a careful histologic examination of the vesical tumors.

Five cases of chronic perirenal hematoma are reported. Preoperative tests were performed to assess the malignant or benign nature of the lesions which were observed some time after the dramatic episode which marked their onset. The varying characteristics of the disease showed by different imaging techniques (urography, arteriography, US, CAT) are such that only surgery can remove all doubts in the majority of cases.

The Authors describe a case of simultaneous, contralateral, transitional cell carcinoma of the ureter in a 64-year-old man. Surgical conservative therapy was performed. The patient is well and free from recurrence 3-years after.

We report a case of inverted papilloma of the ureter. To date it is the 12th case documented. The lesion was treated by conservative surgery; negative controls following the excision for 5 years represent a further proof of the benign nature of these tumors.

The purpose of this study has been to establish the possible presence of incidental carcinoma among men with benign prostatic hyperplasia. During the period 1983-1987, 954 patients with benign prostatic hyperplasia, have been undergone transvesical prostatectomy. Prostatic tissue has been studied with sagittal sections. Sections on the surgical specimens were taking every 0.5 Cm. In this way we have obtained from 6 to 15 sections in every prostate gland for microscopic examination. The incidence of incidental carcinoma of the prostate was found to be 5.45 per cent and it represent 24.88 per cent of all prostatic adenocarcinomas.