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Bulking therapy for the minimally invasive treatment of stress urinary incontinence (SUI) may be offered to women with urodynamic SUI, wishing to avoid the complications associated with more invasive surgery, on the basis of low operative morbidity and low longterm success rates. These bulking agents may be injected by a retrograde or antegrade technique in the periurethral tissue around the bladder neck and proximal urethra. This therapy is strongly dependent on the anesthetic technique of choice; moreover its application as an outpatient procedure implies the potential for a cost-effective treatment for selected patients with SUI. In the present paper all factors affecting the choice of different types of anesthetic techniques are discussed. [ABSTRACT FROM AUTHOR]

In order to guarantee urinary and fecal continence as well as correct pelvic statics, the perfect neuroanatomical integrity of the pelvic floor muscles is mandatory. As Dickinson stated: "There is no considerable muscle in the body whose form and function are more difficult to understand than those of the levator ani, and about which such nebulous impressions prevail". Clinical implications of pelvic floor anatomy and nerve supply are evident: a denervation of this muscle group and the consequent muscle dysfunction could result in urinary and/or fecal incontinence, as well as pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

BACKGROUND. The management of bilateral renal stones still represents a therapeutic challenge and synchronous bilateral percutaneous nephrolithotomy (PCNL) appears to be a well tolerated, safe and relatively rapid procedure with a favorable cost-benefit ratio. The purpose of the present study is to report our experience in the synchronous percutaneous treatment of bilateral renal stones. METHODS. We retrospectively evaluated clinical files from 4 consecutive patients (BS, BE, OCB, FL), who underwent a synchronous bilateral PCNL, performed by the same operator (ZF), for the management of renal persistent and/or recurrent stones after extracorporeal shock wave lithotripsy, or other surgical maneuvers. From each patient's file we recorded a clinical history, any peri- and post-operative complication, any therapeutic resolution employed and the outcomes in terms of stones persistence/recurrence. RESULTS. Overall, 3 men (BS, BE, FL) and 1 woman (OCB), their age ranging from 31 up to 76 years, consecutively underwent synchronous bilateral PCNL. In 75% of cases a calcium-oxalate nephrolithiasis was found. We did not find any peri- or post-operative complication. All patients were stone-free after a mean follow-up of 12 months (range: 3-24 months). CONCLUSIONS. Synchronous bilateral PCNL is a relatively safe procedure; it may be performed in selected patients without increasing the morbidity of this surgical maneuver. The simultaneous treatment of the contra-lateral kidney may be taken into account only when the PCNL of the first side has been performed quickly and easily without any pen-operative complication. [ABSTRACT FROM AUTHOR]

Euthyroid sick syndrome is related to profound changes in thyroid metabolism induced by nonthyroidal diseases. To determine whether children with newly diagnosed Hodgkin disease might present thyroid abnormalities and to establish their predictive value, the authors performed regular thyroid function testing. Seven children (5 M, 2 F) with a mean age of 10.4 years (range: 4.6-15 years) at diagnosis were studied for a period of 6.9 years (4.2-10.5 years). Five patients presented at diagnosis with euthyroid sick syndrome characterized by borderline low thyroxine circulating levels (T3 0.8-1.3 ng/mL, FT3 1.5-1.7 pg/mL) and mildly raised TSH (4.6-5 μ U/mL). Thyroid function turned normal within 6 months of therapy. Subsequently, 3 children developed overt hypothyroidism (T4 35-40 ng/mL, FT4 2-7 pg/mL, TSH 5.5-11 μ U/mL) requiring substitution therapy. Euthyroid sick syndrome was not associated with a poorer outcome in terms of survival or long-term thyroid consequences. Thyroid function testing should be performed routinely at diagnosis and thereafter in children with Hodgkin disease to detect subtle abnormalities. [ABSTRACT FROM AUTHOR]

PURPOSE. Intravesical instillation of Gemcitabine may represent a useful secondline chemotherapy in case of non-muscle-invasive bladder cancer. Herein, we reported our experience with intravesical Gemcitabine in a group of patients affected by high-grade transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS. We retrospectively analyzed a total of 17 patients (15 males and 2 females), affected by high-risk superficial bladder cancer, who were refractory, intolerant or not eligible to intravesical BCG immunotherapy. Each patient received 2000 mg of Gemcitabine diluted in 100 mL of 0.9% saline solution, administered twice a week for 6 weeks. At start, TCC stage and grade were: CIS in 10 patients, TaG3 in 5 and T1G3 in the remaining 2 cases. Those with no macroscopic lesion and negative cytology and histology were considered as complete responders; those with only positive cytology as partial responders, and those with positive biopsy or evidence of macroscopic lesions as non-responders. RESULTS. Patients' mean age was 71.5 yrs (± 7.3 yrs standard deviation). Overall, median follow- up was 12 months [interquartile range (IQR) 9-15 months]. A complete remission was achieved in 10 cases (58.8%), a partial response in 2 (11.8%), while 5 patients (29.4%) were considered as non-responders. Tumor stage and/or grade progression was observed in 26.7% of the cases. Overall, the 6-month recurrence-free survival was 33.3%. Drug toxicity was relatively low: 2 patients developed a grade II dysuria (NCI-CTC criteria); fever >38° was observed in 1 case. CONCLUSIONS. Although our experience and follow-up are still rather limited to formulate any conclusive assessment, our study seems to confirm that Gemcitabine could be used as a safe and efficient intravesical chemotherapy agent even in high grade TCCs, representing a promising second-line option in those cases who failed, were intolerant or not eligible to BCG therapy. [ABSTRACT FROM AUTHOR]