Search

Objectives: To evaluate the influence of two differently acting antiandrogens, finasteride (FIN) and cyproterone acetate (CPA), on the natural history of hematuria associated with benign prostatic hyperplasia (BPH) in a prospective, randomized, controlled study., Methods: Forty-two patients with hematuria episodes due to BPH were randomly allocated to three subgroups of 14 patients each and treated daily with either 5 mg FIN or 100 mg CPA or were placed in a watchful waiting arm. Patients were evaluated at 3-month intervals, and 40 patients had at least 1 year of follow-up., Results: Four patients in the FIN group (30%) and three in the CPA group (23%) presented with recurrent hematuria. In both groups, the bleeding episodes were treated conservatively and required no hospitalization. In the control group, 8 patients (57%) presented with recurrent bleeding; in 4, the bleeding was severe and required some form of intervention (catheterization or transurethral prostatectomy). When the frequency and severity of the hematuria episodes were analyzed over time, a statistically significant difference for FIN versus control was present at 9 and 12 months (analysis of variance, P = 0.035 and P = 0.009, respectively). A similar difference was evident for CPA versus control at 9 and 12 months (P = 0.028 and P = 0.008, respectively). No statistically significant difference was present between the FIN and CPA groups. Interestingly, no statistically significant effect in bleeding recurrence for both CPA and FIN over controls was present at 3 and 6 months of follow-up., Conclusions: Both FIN and CPA seem to exert a comparable control in hematuria recurrence in patients with BPH, thus confirming the rationale behind the use of antiandrogens for such a purpose. Our results support the hypothesis that any antiandrogen, irrespective of the mode of action, would alter the natural history of BPH-associated hematuria. Interestingly, our results indicate that the speed of action of FIN may not be as rapid as previously described.

We report 2 cases of penile lipomas. Although the simultaneous sexual dysfunction proved to be phsychogenic their surgical excision improved their sexual life.

Objective: To investigate the association of retrocaval ureter with other congenital abnormalities., Methods and Patients: Two new cases of retrocaval ureter are discussed and a detailed electronic search of the literature was mainly focused on the concomitant abnormalities. The first of our patients had also a glandular hypospadias and a supernumerary lumbar vertebra, while the second one had syndactylia (fixed toes) in both feet. Results. The review of the literature revealed that 21% of the cases of retrocaval ureter present with concomitant abnormalities mainly from the cardiovascular system and the genitourinary tract., Conclusion: Diagnosis of retrocaval ureter should increase the awareness of the responsible physician on the possibility of concomitant malformations where treatment could prevent future symptoms.

We report our experience with two cases of late migration of the suture and bolster occurring 2 years after a modified Stamey endoscopic bladder neck suspension. Delayed migration of the suture and bolster after an endoscopic bladder neck suspension across tissue planes, with subsequent erosion into the bladder, is uncommon. Recurrent urinary tract infection and mild suprapubic discomfort were the only symptoms. Cystoscopy was the only helpful diagnostic tool and should be considered early in the evaluation of this kind of patients. The mechanism of migration of the cuff and the operative technique are discussed.

Aims: To compare patient compliance with treatment and the dosages of vaso-active drugs used, for the management of impotence in diabetic and non-diabetic patients., Methods: Eighteen diabetic and a control group of 22 non-diabetic men were followed up regularly for 7 years after they had begun self-injections for severe erectile dysfunction. Rigiscan was used for the objective determination of the initial dosage and then doses were regulated in order to introduce an erection suitable for penetration and maintenance of erection for 30 min., Results: Sixteen of 18 diabetic men are still using self-injections successfully after 7 years while of the 22 non-diabetic men, only 7 still continue injections. Compliance of diabetic men with treatment is significantly higher compared to the control group (p = 0.001). Doses of prostaglandin E(1) (PGE(1)) or mixtures of PGE(1) and papaverine (PAP) had to be increased over time. Although self-injections were a safe kind of treatment and no major complications were observed in both groups, a decrease in the frequency of injections was observed, particularly in the diabetic group, but this was not statistically significant (p = 0.15)., Conclusions: Diabetic patients with severe erectile dysfunction have much higher compliance with self-injections than the non-diabetic patients. They respond initially to reasonable doses of PGE(1) but over time need increasing doses of PGE(1) or mixtures of PGE(1) and PAP. Frequent follow-up visits and the adjustment of dosage to continue the success of therapy may prevent patient dissatisfaction and drop-out from treatment. Patients treated with self-injections decrease the frequency of injections over time. They are satisfied with less frequent but successful intercourse and have a low risk of side-effects.

Purpose: The purpose of the present study was to compare the standard metal stents with internally and externally coated metal stents in the pig model., Materials and Methods: In nine female pigs weighing between 25 and 30 kg, the metal stents were randomly placed in either the right or left ureter, for a total of 18 stented ureters. Six ureters were stented with a Wallstent (Schneider, Zurich, Switzerland), six with a Passager stent (Boston Scientific, Natick, MA, USA), and six with a Corvita endoluminal graft (CEG) (Boston Scientific, Natick, MA, USA). Patency was examined by nephrostotomography 24 hours and 21 days after the initial procedure., Results: Free flow of urine through the stents into the bladder was revealed in all ureters with the exemption of four cases where a Passager stent migrated into the bladder, jeopardizing ureteral patency. The Wallstent generated mild inflammation with metaplasia of the urothelium; the CEG a more pronounced inflammatory response in the adjacent ureter; and the Passager stent severe inflammatory reaction with necrosis of the urothelium. The sections of the Wallstents revealed the presence of a mild polypoid reaction adherent to the internal surface of the devices. The coated stents showed no tissue ingrowth through the lining material into the ureteral lumen, and thus, the urothelium was compressed beneath the prostheses., Conclusions: Our experimental results suggest that the standard Wallstent generates less inflammation of the surrounding tissues than coated stents. The coated stents have the advantage of minimal tissue ingrowth but have a tendency to migrate toward the bladder.

Objective: To evaluate the incidence of pharmacologically induced priapism in the diagnostic and therapeutic management of erectile dysfunction., Patients and Methods: Over a period of 7 years, 685 men were investigated for erectile failure. They underwent a simple test with vaso-active drugs, and the nonresponders were further investigated. Eventually, 83 men began autoinjections and 45 still continue., Results: Eight (1.2%) cases of priapism presented during the simple test with vaso-active drugs in these patients, while none occurred during self-injection treatment. Three were prolonged erections induced by prostaglandin E1 (PGE1) and 5 by papaverine (Pap). Six were treated safely with intracavernosal injection of etilephrine without blood aspiration., Conclusion: Priapism is always a potential phenomenon where no individual, no particular drug and no specific dose are completely safe. It may be caused even with 5 microg of PGE1 or 7.5 mg of Pap. Auto-injection therapy however is a safe kind of treatment in well-experienced patients. Careful regulation of the doses and practice in the use of vaso-active drugs may reduce the priapism rate.

Retrograde ejaculation is an uncommon cause of infertility in otherwise healthy men. We hereby report a previously undescribed verumontanum hyperplasia as a cause of retrograde ejaculation in a 32-year-old male that was successfully treated by transurethral resection., (Copyright 2001 S. Karger AG, Basel.)

Objective: To assess the efficacy of sildenafil as a first-step diagnostic and therapeutic tool for erectile dysfunction (ED) and to evaluate the consequent changes in the management of male sexual insufficiency., Materials and Methods: Sildenafil in titrating doses up to 100 mg was prescribed to 50 men presenting to a sexual dysfunction clinic with medically documented ED. They had not undergone any specific diagnostic test before starting sildenafil., Results: Of the 50 men, 24 (48%) responded to sildenafil. Of these, 8 (33.3%) responded to 50 mg and 16 (66.7%) to 100 mg of sildenafil. Of the responders, 9 representing 18% of all studied men were discharged achieving spontaneous erections in a mean follow-up of 5.3 months. Men with no medical history, men with hypertension and men with mild coronary artery disease responded better., Conclusions: The sildenafil test revealed that 48% of men responded to this therapy with no requirement for more invasive tests and that 18% of men required no further treatment at all. In addition this test reduced the overall cost of the diagnostic investigation. It is proposed that the sildenafil test should be used in cases with no significant medical history or in men with hypertension or mild coronary artery disease although almost all men with ED could be categorized as sildenafil-responders or sildenafil-resistant. It is also suggested that the sildenafil test would result in the ability for more men with ED to be managed exclusively in the primary care sector.

Purpose: To evaluate conservative management of renal echinococcosis in cases with normal renal function and active disease., Patients and Methods: From a series of 12 consecutive patients with primary renal echinococcosis, nephrectomy was suggested to 4 patients because of kidney destruction. One patient who denied surgery and 5, in whom serological tests were positive, were given mebendazole for 30 days. 3 patients with no evidence of active disease were not given any medication., Results: The patient who denied nephrectomy and 1 out of 5 with positive serological tests did not respond to mebendazole treatment. The latter underwent a cyst excision. Thus, 4 responders to mebendazole and 3 who were not given any medication, avoided surgery and continue to have negative serological tests for more than 3 years., Conclusion: Conservative management and long term follow up are proposed for the non-active or mebendazole-responsive patients. For the non-respondents or the cases with kidney destruction, surgery is the only hope for cure.

Objective: To investigate epidemiological and clinical features of Peyronie's disease in an unselected group of patients not seen by a urologist before., Patients and Methods: A series of 134 consecutive cases with Peyronie's disease was evaluated regarding to the age at diagnosis, the symptoms and signs of the disease, and the site and formation of the scar. The medical history which could be possibly related with the onset of the disease was investigated as well., Results: The disease mainly affected middle-aged men. While all men had a palpable scar, only 51 (38%) had noticed the induration. Curvature (mean: 35 degrees) appeared in 87 men (65%) and caused sexual dysfunction due to severe penile deformity in 16 men (11.9%). 53 patients (39.5%) referred painful erections. In 11 men (8.2%) the onset of the disease was noticed after auto-injections of vaso-active drugs for the treatment of previous erectile dysfunction, while 18 (13.4%) had a history of penile trauma during sexual intercourse or manipulation. No specific relation with diabetes mellitus and Duputren's contracture was identified. Scars, like elongated indurations with vague bounds, were mainly formed (77.6%) in the dorsal midline., Conclusions: The mean age of patients at diagnosis, the site of penile scars, and the activities of the affected men could advocate the hypothesis that trauma is the main causal factor for Peyronie's disease. In 21.6% of the patients, the lesion occurred after a traumatic activity. Sexual dysfunction due to severe penile curvature affected a small proportion of the patients. Thus, due to the diminution of pain spontaneously or after treatment, the patients with Peyronie's disease may have a normal life with satisfactory sexual function. In some selected cases surgery offers an effective result.

Pheochromocytoma of the bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We describe a case of bladder pheochromocytoma in a 42-year-old female in which macroscopic hematuria was the only alarming symptom. The diagnostic and operative issues of this type of tumor are discussed, along with the challenging treatment option of transurethral resection. Diagnosis, treatment and follow-up trends of this rare tumor are reviewed., (Copyright 2000 S. Karger AG, Basel)

Background: The use of retinoids as differentiation therapy is a novel approach to prostate cancer. Retinoids act via their own nuclear receptors, RARs and RXRs, modulating gene activity, cell growth and differentiation. This study provides new data on the content and cellular distribution of RARalpha protein in prostate cancer specimens, in correlation to tumor grade and proliferative activity., Material and Methods: A total of 84 cases of primary prostate carcinoma, divided into 3 subgroups according to tumor grade, were immunohistochemically evaluated for retinoic acid receptor-alpha (RARalpha) and Ki67 using the streptavidin/peroxidase method on formalin fixed, paraffin embedded tissues., Results: RARalpha positivity was detected in all cases of prostatic carcinoma, with a more profound expression in well differentiated cancers. A statistically significant correlation between RARalpha staining and tumor grade was found (ANOVA, p < 0.031). Ki67 immunoreactivity was present in 35.7% of cases, but no correlation with tumor grade was found. When RARalpha staining was correlated with Ki67 positivity, a statistically significant correlation was present (unpaired t-test, p < 0.003)., Conclusions: These findings indicate that RARalpha expression is correlated to some extent with tumor grade and its presence is more profound in highly proliferative tumors. Further studies are needed to establish the possible clinical value of the immunohistochemical evaluation of RARalpha content in tumor specimens.

We report a case of bladder leiomyoma found incidentally in a 66-year-old man during his work up for an adenocarcinoma of the prostate. Transrectal MRI scan appeared to be highly demonstrative of its localization and extent within the bladder wall. It was resected transurethrally.

We herein report a case of a female embryo who died in utero and at autopsy she was found to have bilateral renal agenesis with the extrarenal manifestations of Potter's syndrome together with mermaid syndrome which is a rare combination. From all the anomalies of the upper urinary tract bilateral renal agenesis seems to have a cardinal role in the survival of the embryo afflicted with the spectrum of associated anomalies.

Investigating the reliability of using some clinical and laboratory parameters as long-term prognostic factors in properly selected patients for stress urinary surgery could help in the prediction of the long-term result in each case. Toward this goal 51 women were examined prospectively, after they were assessed by clinical and laboratory exams with particular emphasis on urodynamic studies. Out of this group, 41 patients had genuine stress incontinence, and 10 had mixed stress incontinence. Twenty-seven women underwent Burch colposuspension while 24 had Stamey endoscopic bladder neck suspension. In all patients clinical and urodynamic evaluation was done with the same methodology before the operation, and after one month and six months, respectively. The study indicated that 73% of the incontinent women were cured. According to the "analysis of variance" and "correlation analysis" methods the factors which were found to influence the operative result were as follows: (1) Clinical factors including preoperative urgency, U.T.I. and previous gynaecological operations. These factors had negative prognostic value, while the grade of incontinence did not influence at all the outcome of surgery. (2) Urodynamic factors including preoperative residual urine, immediate operative first sensation of micturition, maximum urine flow rate, pre- and immediate postoperative bladder capacity and functional length. These factors influence the operative result negatively or positively according to the deviation from the normal values. Furthermore, the important immediate postoperative change of the urodynamic values was found to determine the result of the operation.

A total of 32 female patients with urinary stress incontinence who underwent a Stamey endoscopic bladder neck suspension were clinically and urodynamically studied pre- and postoperatively. Complete cure was obtained in 78% of the patients and improvement in 6%, the overall success rate being 84% for a mean follow-up of 11.1 months (range 6-19). Complications occurred in 22% of the patients. Comparison of the pre- and postoperative urodynamic data revealed that the maximum urine flow rate, functional urethral length and maximum urethral closure pressure were changed significantly after operation. In addition, when studying the abdominal pressure transmission to the entire urethra during stress, there was a significant conversion of negative to positive pressure transmission after surgical repositioning of the urethra.

Chronic scrotal pain is a common complaint that always causes anxiety to the patient, frequently causes diagnostic difficulties to the general practitioner and usually results in prolonged follow-up in surgical clinics. Careful examination in a urological clinic and ultrasound study in all patients reveals a firm diagnosis in 60%, and the other patients can be reassured and discharged from surgical follow-up, although 19% of them will remain symptomatic.

Burch colposuspension is a very popular operation for the correction of genuine stress incontinence, due to its very good long-term results. The effect of the operation on the urodynamic parameters at the level of the bladder neck evaluated in this study, and correlated with clinical outcome. A total of 29 female patients with urinary stress incontinence who underwent a Burch colposuspension were clinically and urodynamically studied pre- and postoperatively. The urodynamic parameters chosen pre- and post-operatively were: maximum flow rate, residual urine, first sensation, bladder capacity, maximum detrusor pressure, detrusor pressure at maximum flow, functional urethral length and maximum closure pressure. Complete cure was obtained in 76% of the patients and improvement in 14%, the overall success rate being 90% for a mean follow-up of 18.4 months (range 8-27). Comparison of the pre- and postoperative urodynamic data revealed that the maximum urine flow rate, functional urethral length, maximum urethral closure pressure and residual urine were changed significantly after the operation. There were no statistical differences in the other parameters. All the urodynamic results that improved, however, only arrived at the lower limits of the values accepted as standard for normal individuals. This fact, however, did not prevent a good clinical result.

We report 2 cases of large adrenal myelolipoma. Although their fatty nature was found by a CT scan and there was no endocrine activity, surgery was done because of their size and the caused discomfort.

The sensitivity and specificity of prostate-specific antigen (PSA) in prostatic carcinoma is of considerable interest. In this study, we have assessed PSA and also correlations between positive and negative predictive values of PSA and the prevalence of prostatic cancer. Firstly, cutoff point must be selected as a positivity criterion for prostatic cancer, according to the purpose of the test. Besides sensitivity, all the other operating characteristics are dependent upon the prevalence of the disease. Specificity and positive predictive value increase while negative predictive value decreases when prevalence increases. As the relationship between the age and the prevalence of prostatic carcinoma is well known, the age of the patient becomes a variable of prominent importance when assessing the test.

The number of very aged men who demand prostatectomy for benign disease is increasing. We have assessed surgery results in 79 patients operated during the last four years. Sixty-two underwent endoscopic and 17 open procedure. Mortality rate was 3.7%. Two patients died in the first week and one patient three weeks after surgery. Morbidity rate was 61% but did not significantly affect the final operative outcome. Operative success rate six weeks postoperatively was 87%, satisfactory for this age group. After detailed preoperative evaluation and postoperative care by specialized age care team, prostatectomy is safe, effective and involves low-cost treatment.

Whilst the diagnosis of pyonephrosis and renal abscess is fairly easy, the source of obstruction and infection is an important indicator of treatment. The association of kidney tumours with these inflammatory manifestations has not previously been emphasised. Reviewing our cases of pyonephrosis and renal abscesses, we report 4 patients with concomitant tumours of the kidney and discuss their management.

Our paper reports 7 cases of idiopathic granulomatous orchitis. Testicular trauma and genitourinary tract infection were the only important conditions in the past history, and were possibly related to the etiology of this disease. The clinical appearance of idiopathic granulomatous orchitis varies, and it is difficult to differentiate from testicular cancer, the diagnosis usually being made on histological examination after orchiectomy. For young patients and those with single testis, inguinal exploration and frozen section are recommended.

We present a case of sarcoidosis of the ureter which caused obstruction. This 'one-organ' localization is very rare and raises diagnostic problems.

Twenty-six boys were evaluated and treated for posterior urethral valves. At the time the valves were diagnosed unilateral or bilateral vesicoureteral reflux was present in 58% of the ureters and 69% of the children, while dilatation of the upper urinary tract was present in 88% and 92%, respectively. There was a variety of symptoms and signs, but the most prominent in neonates and infants were vesical urine retention, palpable kidneys and failure to thrive, whereas in the older children voiding dysfunction, incontinence and urinary infection were the most common. Twenty-four out of 26 boys were managed by primary valve ablation and in 62.5% of them this type of treatment was adequate in resolving or sufficiently improving clinical manifestations and roentgenologic findings, requiring no further management. Urinary diversion in the form of vesicostomy and cutaneous ureterostomy was preserved for those patients who did not improve with valve ablation alone. The current aspects concerning posterior urethral valves are also discussed.