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Objective To assess urethral vascularization in healthy young women, using colour Doppler ultrasonography. Subjects and methods Eleven healthy young women volunteers (mean age 33.6 years, range 24–46) with no pelvic floor disorders and no history of incontinence were assessed. The subjects underwent colour Doppler ultrasonography using a 4–7 MHz convex broadband transducer. Translabial sagittal scans of the urethra were taken when the subjects had a full bladder, both during the oestrogenic and progestogenic phases. The colour Doppler ultrasonography parameters were optimized to detect slow flows in the anterior and posterior distal, middle and proximal urethra. A rank-sum nonparametric test was used to assess differences between the resistive indices. Results The statistical evaluation showed a significant difference in the resistive index only in the anterior urethra, between the distal and middle plus proximal urethra, in both the progestogenic (P = 0.002) and oestrogenic (P = 0.0127) phases. Conclusions This study confirmed that the vascularization of the urethra plays an important role in the ‘seal’ effect, which is considered one of the most important factors in urethral closure. There was a significantly greater resistive index in the anterior proximal urethra than in the middle and distal urethra. These findings suggest that the seal effect is related to the existence of a rich venous urethral vascularization, involved in the mechanism of urethral closure. Colour Doppler ultrasonography of the urethra seems to be feasible and useful for understanding the mechanism of the vascular component in female continence.

To investigate by questionnaire the prevalence and characteristics of urinary incontinence (UI) in a female population aged between 18 and 49.Of 44,095 females aged 18-49.9 living in our urban area a sample of 10,000 subjects was sent a questionnaire and 3557 replied. The age-based analysis was performed on 2900 of these.The overall prevalence of UI was 20\%. 11\% had suffered from nocturnal enuresis before 18 years old, 47\% of parous women noted a relationship between the beginning of UI and delivery. Among the incontinent women 83\% lost urine with physical exertion, and 44\% had urge incontinence, 18\% used diapers, 20\% had consulted a physician and half of these had been referred for medical, surgical or rehabilitative therapy, 50\% reported past or present urinary infections, 8\% complained also of faecal incontinence, 22\% considered loss of urine embarrassing and humiliating but only 6\% revealed frustration and 2\% were obliged to stay at home for long periods of time. Of the incontinents 62\% defined themselves anxious or nervous and 22\% of these ascribed an increase of urinary leakage to anxiety or to nervousness, 9\% reported use of antidepressant drugs, 85\% had sexual intercourse and only 2\% considered UI as an impediment to a satisfying sexual activity.UI is a common problem in young women. Urge incontinence seems to be prevalent in

We report our experience in laparoscopic lymphadenectomy in non-seminomatous stage I testicular neoplasia. This technique is an alternative to the formal retroperitoneal lymphadenectomy. Between 1993 and 1996 we carried out 8 retroperitoneal laparoscopic lymphadenectomies in patients, aged 19–40 years, affected by non-seminomatous testicular neoplasia. We removed from 13 to 24 lymph nodes. Operating time ranged between 200 and 300 minutes. The mean stay in hospital was 5 days. Histological findings revealed micrometastatic lymph nodes in half the patients. No complications were reported except in one patient, who underwent TC-guided drain owing to voluminous lymphocele one week after the laparoscopic operation. Normal antegrade ejaculation was preserved in all cases and no retroperitoneal recurrence was noted at a mean 18 months follow-up.

To assess the existence of a vesical hypothalamic reflex by evaluating the changes of plasmatic ADH levels during acute bladder filling in healthy adult volunteers.Twenty normal male subjects aged between 19 and 40 years (average age 31.6 years) were evaluated. All subjects signed informed consent. The subjects had no pathologic blood and urine examination, no cardiovascular, hepatic, renal disease, they were no smokers and they did not take drugs which may interfere with plasmatic ADH levels. A blood sampling at rest condition (time 0) and successively during cystometry in the presence of first sensation, normal and strong desire was carried out. Plasmatic ADH was measured on extracted samples by radioimmunoassay. A one-factor repeated measures analysis of variance was employed to verify the effect of time on ADH levels. The Greenhouse-Geisser and Huynh-Feldt adjustments were adopted to protect against the case of violation of homogeneity of covariance.Statistical analysis did not show significant differences of plasmatic ADH levels between rest condition and bladder filling.We exclude the existence of a vesical hypothalamic reflex and we suppose that extravesical factors may interfere with the plasmatic ADH production during the night.

Testicular trauma is a frequent acquired cause of infertility; being accidents, work injuries and sport activities that are the most common causes of testicular traumas. [1],[2] Strangely, the issue of management of serious testicular trauma and fertility preservation has not been studied extensively before, existing only sporadic reports in international literature. Besides, no guidelines exist on fertility preservation in cases of important scrotal trauma when injury may result in irreparable damage to all testicular tissue (torsion of a solitary testis, bilateral synchronous testicular torsion, and severe bilateral scrotal trauma). [3] The present case report describes the presentation of a young patient who experienced a motorbike accident with an irreparable damage to all testicular tissue in which preservation of fertility through immediate postoperative sperm cryopreservation was performed.

Objectives: We report our preliminary clinical experience with a modification of Ghoneim’s original technique involving reimplantation of ureters in a single tunnel on the right par

The aim of the study was to evaluate the sensitivity of pSEP in patients affected by probable MS.Bladder dysfunction is the presenting symptom in 2\% of patients affected by multiple sclerosis (MS) and may be present in up to 78\% of them. Abnormalities of somatosensory evoked potentials of the pudendal nerve (pSEP) have been found by many authors in patients affected by clinically defined MS, but little is known of diagnostic reliability of pSEP in early stage of MS.Sixteen patients, eleven females and five males, aged between 18 and 45 years old (mean age 28.9), affected by clinically probable MS, were studied. Six of them reported retention or urge incontinence. pSEP with P1 (P40) scalp wave was analyzed. All patients also underwent visual evoked potentials (VEP), SEP of median and tibial nerves (mSEP, tSEP), brainstem acoustic evoked potentials (BAEPs), MRI of the brain and cerebrospinal fluid (CSF) evaluation. Urodynamic study with simultaneous measurement of intravesical, intraurethral and abdominal pressures with external sphincter electromyography was performed.Abnormalities of the evoked potentials were found in all patients. Abnormalities of the pSEP were observed in all the symptomatic cases and in eight of the remaining ten patients; ten showed no responses from the scalp and four showed P1 increased latency. Urodynamic abnormalities were found in 12 patients and MRI showed demyelinating lesions in 13 patients and oligoclonal bands were found in eight of them.pSEP can be worthwhile as part of the initial diagnostic evaluation in patients affected by MS. It provides information of diagnostic relevance and plays a role in screening patients for urodynamic testing, which, however, is more specific for detecting urethrovesical dysfunctions and preventing urological complications.

The association of renal angiomyolipoma and renal oncocytoma in the same kidney is rare, only 7 cases having been previously reported. We report a 69-year-old woman affected by the simultaneous presence of renal angiomyolipoma and oncocytoma in the right side with a decrease of renal function on the left side due to a stenosis of the superior polar branch that was successfully treated preoperatively by angioplasty. An enucleation of renal masses on the right side was performed with renal function preservation after 2 years.

Study design: Prospective study. Objectives: To evaluate the feasibility of color ultrasound imaging of the urethra in association with UPP to diagnose intrinsic sphincter deficiency (ISD). Setting: Italy. Methods: We studied a group of 13 normal female volunteers (mean age 29 years) during the estrogenic phase and a group of 15 patients (mean age 63.9 years) with ISD. All patients and normal volunteers underwent color ultrasound imaging using a 4–7 MHz convex broad band transducer. Translabial sagittal scans of the urethra were obtained. The color ultrasound parameters were optimized for detection of parenchymal slow flows. A subjective score of the degree of vascularization along the entire urethra was established as follows: (a) minimal or absent (1), (b) poor (2), (c) moderate (3), (d) good (4). Statistical analysis, using the non-parametric Mann-Whitney rank sum test, was carried out to determine differences of ultrasound scores between volunteers and patients. Results: The statistical evaluation showed that the differences between the ultrasound scores in the two groups was statistically significant (P

We developed a simplified Politano-Leadbetter ureteral reimplantation associated with the psoas-hitch technique in 10 female patients, aged between 22 and 80 years, who were affected by pelvic ureteral pathology. After the standard ureteral mobilization through an intravesical and extravesical approach, the ureter was brought through the new hiatus and through the new submucosal tunnel to the new meatus in just one step using a new right-angled clamp in which the grasp is effective only in the last 0.5-cm part of the tip. The follow-up ranged from 1 to 3 years and did not reveal any postoperative complications. This technique avoids the damage to the submucosal tunnel and reduces the operating time of ureteral reimplantation.

To assess urethral vascularization in healthy young women, using colour Doppler ultrasonography.Eleven healthy young women volunteers (mean age 33.6 years, range 24-46) with no pelvic floor disorders and no history of incontinence were assessed. The subjects underwent colour Doppler ultrasonography using a 4-7 MHz convex broadband transducer. Translabial sagittal scans of the urethra were taken when the subjects had a full bladder, both during the oestrogenic and progestogenic phases. The colour Doppler ultrasonography parameters were optimized to detect slow flows in the anterior and posterior distal, middle and proximal urethra. A rank-sum nonparametric test was used to assess differences between the resistive indices.The statistical evaluation showed a significant difference in the resistive index only in the anterior urethra, between the distal and middle plus proximal urethra, in both the progestogenic (P = 0.002) and oestrogenic (P = 0.0127) phases.This study confirmed that the vascularization of the urethra plays an important role in the 'seal' effect, which is considered one of the most important factors in urethral closure. There was a significantly greater resistive index in the anterior proximal urethra than in the middle and distal urethra. These findings suggest that the seal effect is related to the existence of a rich venous urethral vascularization, involved in the mechanism of urethral closure. Colour Doppler ultrasonography of the urethra seems to be feasible and useful for understanding the mechanism of the vascular component in female continence.

We report our preliminary clinical experience with a modification of Ghoneim's original technique involving reimplantation of ureters in a single tunnel on the right part of the neobladder forming a 'W' shape.From 1997 to 1999, we performed radical cystectomy with double 'W' orthotopic neobladder construction and uretero-ileal reimplantation using our modified Ghoneim's technique on 11 male patients, aged 40-74 (mean 65.5) years, affected by invasive bladder cancer.No postoperative complications were observed. After a mean follow-up of 12.5 months all patients are free of recurrences.In our hands the modified Ghoneim's technique seems to reduce the mean operating time required to tailor the uretero-ileal anastomosis and guarantee greater stability of the anastomosis itself.

To describe a case of congenital mesoblastic nephroma (CMN) treated by radical nephrectomy with no evidence of relapses after five years in spite of an unusual positivity for proliferating cellular nuclear antigen (PCNA).A three-month-old child presented a right renal mass with compression of the inferior vena cava. Excretory urography showed an intrarenal mass with distortion of the calyceal system. There was no evidence of metastasis. Radical nephrectomy was carried out; no adjuvant therapy was given. Histological and immunohistochemical studies were performed.The tumor was a 6 x 6 x 5 cm solitary mass extending into perirenal tissue, involving the hilar vessels but not the ureter. Histologically, it has been classified as a congenital mesoblastic nephroma of the classic variant. Positive reaction for vimentin and actin was observed. Strong positivity for PCNA and negativity for P53 were revealed.PCNA is considered to be a reliable marker of potential malignancy. This, however, contrasts with the biological behavior of our case. Further evaluation is required for correct interpretation of this additional information and to avoid inappropriate aggressive therapy.

The authors experience in the surgical treatment of endocrine tumours of the digestive tract is reported. Particularly, they emphasize that in spite of the several syndromes associated with these neoplasms, diagnostic and therapeutic concepts herein analyzed are similar.

A total of 15 patients, previously undergoing radical retropubic prostatectomy (RRP) in 9 cases (60%) and TURP in 6 cases (40%), aged between 59 and 81, (mean age of 70.07 years, mean SE 1.78, SD 6.89) underwent bone anchored sling placement for SMI. All the patients were preoperatively evaluated with a detailed clinical history, physical examination, cystourethroscopy for possible anastomotic or urethral stricture, urinary flow, cystometry to assess the bladder compliance and the presence of any overactive detrusor contraction (ODC), abdominal leak point pressure (ALPP), urethral pressure profile (UPP). The surgical technique recently reported by others consisted in a perineal approach with the placement of a trapezoid segment of sling (lower lenght 5.5 cm, upper length 4 cm and 4 cm high) at the level of the bulbar urethra (1). In our series the sling was constituted of cadaveric fascia alone in ten cases (66%), of cadaveric fascia plus polypropilene mesh in two cases (13.3%), of a cellular porcine dermal collagen plus polypropilene mesh in two cases (13.3%) and of dacron in one case (6.7%). The sling tension was adjusted to create an outflow resistance of 30 to 50 cm H2O. The catheter was removed the next morning for voiding attempt. Follow-up was done at 6 weeks and successively every 3 months with the reassessment of physical examination, 1-hour pad test, as standardized by ICS in 1983, of cystometry, of ALPP and urinary flow. A Wilcoxon test was carried out to verify any statistical difference between preoperative and postoperative ALPP. Results

Objectives: To assess the urodynamic and clinical outcome of a laparoscopic auto-augmentated bladder. Methods: Laparoscopic bladder autoaugmentation in a 27-year-old woman with an incomplete spinal cord injury at T12 level with urge incontinence caused by a hyperreflexic bladder. Results: Six months later the patient voids by Valsalva's manoeuvre every 3 h and remains dry day and night. The radio-urodynamic study, performed 2 months later, revealed an intact bladder with a diverticulum of anterior wall and a capacity of 510 ml with filling rate of 100 ml/min without evidence of leakage of infusion water. Conclusion: Laparoscopic retropubic auto-augmentation allows a brief hospital stay and minor postoperative discomfort. Moreover the laparoscopic approach should not complicate or preclude subsequent enterocystoplasty if necessary. Spinal Cord (2000) 38, 59–61.