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Introduction: The authors present the functional long-term follow-up by means of digital fluorographic video-urodynamics (DFVUDM) of two different surgical urinary diversions. Materials and Methods: 64 of 101 patients submitted to radical cystectomy from 1983 to 1999 for infiltrating bladder cancer, were diverted by means of an Alcini’s ileocecourethrostomy (ICUS+T), and the remaining 37 patients by means of an ileal reservoir (IR). All of those orthotopically diverted patients were submitted to an accurate follow-up which included DFVUDM 1, 3, 6, and 9 years after the surgical procedure (mean follow-up 51 ± 42 months). Results: All the evaluated patients showed a neobladder with good function during both the filling and the voiding phases. In 88.8% of the DFVUDM examinations, it was possible to find a residual peristaltic activity of the neobladder walls. Such a residual peristaltic activity caused urinary leakage during the examination in 11.1% of cases, while vesico-ureteral reflux was detected in 12.5%. The patients voided by relaxing the perineal floor and/or by contracting the abdominal muscles: the emptying of the reservoir was often excellent with average residual urine of 28.5 ml. None of the patients needed clean intermittent catheterization. EMG evaluation of the pelvic floor in some of patients showed a peculiar EMG pattern characterized by an insufficient voluntary control of the perineal musculature with a slight increase of EMG activity during bladder filling. Moreover, an insufficient relaxation of the pelvic floor muscles in the beginning of and during the micturition has been seen. This particular EMG pattern was present in 22.22% of all patients included in this study while it was particularly high (81.81%) in patients with leakage. Conclusion: DFVUDM evaluation represents a highly sophisticated tool which allows an accurate long-term morphofunctional evaluation of the urinary diverted patients. In this study, it is shown that the functional results of the two studied surgical procedures, namely Alcini’s ICUS+T and IR, are quite similar, demonstrating that the taeniotomies on the cecal tract may have almost the same functional effects of detubularization. Although DFVUDM revealed imperfect functional performances in some patients, the quality of life of diverted patients in our series seems to be satisfactory.

TAU and CT are, after cystoscopy, the two most largely used methods in the diagnosis and the staging of the bladder tumors. TRUS is mostly used in the pathologies of the prostate and the seminal vesicles. 38 patients (34 M and 4 F) suffering from bladder cancer are included in this study in the period from July 1995 to January 1997. They are evaluated with TAU, TRUS and CT in order to evaluate the sensitivity and the specificity of TRUS in the diagnosis and the stadiation of bladder tumors. The patients included in this study are divided in two subgroups as patients having superficial and infiltrating tumors according to pathologic stage after TURB or radical cystoprostatectomy. Specificity and sensitivity values, overstaging and undestaging rates are calculated for each group. In the superficial tumors, TAU had a sensitivity and specificity of 72.2%, while with CT these values were respectively 70% and 75%; in the infiltrating tumors, TAU presented sensitivity of 65% and specificity of 70% while CT presented respectively 72.2% and 77.5%. With TRUS these values were 88.8% and 94.4% in the superficial tumors and 90% and 95% in the infiltrating tumors. The method with the highest overstaging rate was CT with 33.3% while the ones with the highest understaging rates were TAU and CT with 22.2%. The sensitivity with TRUS was 100% in a total of 29 infiltrating and superficial tumors of the trigone while it was only 55.5% in the tumors of the lateral walls and the dome. With TAU these values were respectively 82.7% and 22.2%, with CT respectively 79.3% and 44.4%. The specificity with TRUS was 100% for the tumors of the lateral walls and 77.7% of the dome; with TAU these values were respectively 75.8% and 55.5% with CT 75.8% and 77.7%. In conclusion, TRUS may be used with a high sensitivity and specificity in the diagnosis and the stadiation of infiltrating and superficial bladder tumors situated at the peritrigonal zone and in the diagnosis of tumors situated in other regions of the bladder.

With the progressive aging of the population in industrialized countries, urological pathologies are also increasing and creating a socio-sanitary problem for the community. To investigate this problem we retrospectively analyzed a heterogeneous sample of 283 patients, 134 males and 149 females who attended our urodynamics laboratory.The female patients were subdivided into 6 categories and the male patients into 7 categories according to their urodynamic diagnoses. Their age distributions were compared with those of the population of the region of Lazio in Italy in order to calculate the "risk tendency".The most frequent pathologies in males were bladder outlet obstruction (BOO) associated or not with detrusor overactivity (DO), and in females it was cystocele associated or not with DO or obstruction. There is a significant increase in these urological pathologies in older people. The relative risks for the females increase from age 20-29, stabilize at around 50 to 69 years and decline thereafter. The risk approximately doubles every ten years of age from 20 to 50. At ages 50-69 the risk is about 8 or 9 times higher than the risk at age 20-29 and double that of women aged over 70 years. The risk for the males also approximately double for every ten years of age. Men aged 60-69 have about 25 times the risk of these pathologies than men aged 20-29, and in the oldest men, those over 70 years, the risk is almost 40 times as high.

The Authors report a rare case of detrusor areflexia due to a sacral column chordoma characterized as initial symptomatology, by dysuria and recurrent urinary tract infections. The patient was treated for a long time in a symptomatic way by her physicians. The Authors while discussing the case, underline the importance of an accurate differential diagnostical framing in patients with voiding and/or anorectal dysfunctions of uncertain nature. This framing must exclude those voiding pathologies of neurological origin which are frequently evinced merely by an aspecific voiding symptomatology of dysuric or irritative nature.