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Purpose. Intralesional therapy is a less invasive method for the treatment of Peyronie's disease. The objective of this study was to evaluate safety and tolerability of intralesional injections of Iloprost (I2 Prostacyclin analogue) for its property to suppress in fibroblasts CTFG (Connective tissue growth factor) production, which acts in concert with TGF-ß to stimulate the fibrotic process.?Methods. Nineteen patients with Peyronie's disease were preliminarily evaluated by considering the degree of penile curvature, plaque size and local and systemic symptoms. Each patient then received weekly intralesional injections of 200ng of Iloprost in 1 ml of normal saline for 4-5 weeks. If tolerated, the single dose increased weekly to the maximum of 400 ng (2 mL). Results. The treatment has shown that all patients seem to well tolerate a 200 ng Iloprost dose; 7 of them reached a 300 ng dose and 6 tolerate a 400 ng dose without showing side effects. There was no placebo control group in this study.?To evaluate the efficacy of the treatment, the absence of objective parameters (except for the auto-photograph of penis in erection) led us to develop a subjective questionnaire that was given to all patients to assess sexual function, pain reduction, ecc. Conclusions. Due to the relatively small size of the sample, the efficacy evaluation has been restricted to check the questionnaire reliability. Iloprost is well tolerated to a dose of 400ng in the local treatment of Peyronie's disease.

INTRODUZIONE Descriviamo il caso di un paziente con presentazione clinica come da rottura dei corpi cavernosi e diagnosi conclusiva di lacerazione della fascia di Buck con associata lesione vascolare. MATERIALI E METODI Paziente di 36 anni, che giunge alla nostra osservazione con ematoma penieno da trauma intercorso durante rapporto sessuale. Dopo esecuzione in urgenza di ecocolor-doppler penieno sospetto per lesione di tonaca albuginea del pene, il paziente viene immediatamente sottoposto a esplorazione chirurgica che rivela la presenza di lacerazione della fascia di Buck con contestuale lesione vascolare; la tonaca albuginea risulta integra. RISULTATI Riportiamo la tecnica chirurgica utilizzata. Il paziente, a un follow up a breve e medio termine, ha mostrato una normale attività erettile, invariata rispetto a prima dell'evento traumatico. DISCUSSIONE E CONCLUSIONI I traumi del pene rappresentano una rara entità clinica che si configura all'interno delle urgenze in urologia (1). I pazienti con presentazione clinica di frattura peniena vengono comunemente sottoposti a terapia chirurgica immediata con l'intento di riparare un lacerazione della tonaca albuginea. In alcuni casi, nonostante la presentazione clinica e l'ausilio delle metodiche di imaging, si osservano casi di falsa frattura peniena (2). In letteratura vengono riportati casi simili: solitamente questi vengono attribuiti a lesione della vena dorsale superficiale del pene o a sanguinamenti aspecifici del dartos (2,3). Nel caso clinico da noi trattato risulta non comune la localizzazione della lesione a livello della fascia di Buck e si evidenzia come l'esplorazione chirurgica precoce rimanga insostituibile nella gestione dei traumi del pene.

INTRODUZIONE La traumatologia peniena rappresenta una rara entità che si configura all'interno delle urgenze in urologia. La presentazione clinica è tipica e richiede una terapia chirurgica precoce al fine di evitare alterazioni estetiche e funzionali (1). MATERIALI E METODI Si riporta la nostra esperienza nel trattamento chirurgico dei traumi penieni con tecnica di accesso chirurgico mediano peno-scrotale in sostituzione della classica incisione circonferenziale subcoronale con conseguente degloving penieno. RISULTATI Tutti i pazienti trattati venivano alla nostra osservazione con ematoma penieno, in alcuni casi diffuso anche in sede scrotale e perineale. In un caso non era presente rottura dei corpi cavernosi,ma lacerazione della fascia di Buck associata a lesione vascolare. L'accesso con incisione mediana ventrale peno-scrotale ha permesso in tutti i casi una immediata identificazione delle lesioni riscontrate e un'agevole riparazione chirurgica. Al follow up tutti i pazienti hanno conservato una normale attivita erettile, invariata rispetto a prima dell'evento traumatico. DISCUSSIONE E CONCLUSIONI Diverse tecniche sono state proposte nella riparazione chirurgica delle fratture peniene (2): degloving penieno, incisione longitudinale lungo l'ematoma,incisione sovrapubica, incisione inguinoscrotale, accesso mediano ventrale. L'accesso penoscrotale da noi utilizzato sembra vantaggioso per diverse ragioni: sembra consentire un accesso più rapido ai fini dell'identificazione della lesione traumatica; permette di esplorare velocemente la base dei corpi cavernosi, a livello della giunzione penoscrotale, sede dove più frequentemente origina la lesione; evita, al contrario del degloving penieno, estesi scollamenti degli strati dartoici; questi ultimi possono risultare difficoltosi specie quando presente un esteso infarcimento emorragico; è consentito infine un accesso diretto all'uretra peniena, così da potere riparare eventuali lacerazioni della stessa, ove presenti.

INTRODUCTION. Serenoa repens (saw palmetto) has been employed for the treatment of lower urinary tract symptoms (LUTS) for several years. Its mechanism of action is believed to be due to antiandrogenic, antiproliferative and antinflammatory properties. An association of Serenoa with the nettle “Utica dioica” showing antiproliferative activity and the pine “Pinus pinaster” derivative, showing antinflammatory action, has been proposed in recent years. Such an action is hoped to act not only by reducing LUTS but also by preventing the development of prostate cancer. MATHERIAL AND METHODS. During the years 2007 and 2008, 320 patients suffering from LUTS were treated with an association of Serenoa repens 320 mg, Utica dioica 120 mg and Pinus pinaster 5 mg, named IPBTRE. This treatment was administered to all patients for a minimal duration of 30 days to a maximum of a year, either alone or in association with antibiotics or alpha-blockers, if needed. Outcome analysis was based on evaluation of symptoms, prostate volume and maximum flow rate (Qmax). RESULTS. From a careful analysis of the data collected in our database, the following observations can be made: age varied between 19 and 78 years. The patients were affected by BPH in 46% of cases, chronic prostatitis syndrome in 43%, chronic genital-pelvic pain in 7% and other conditions in 4%, the absolute numbers being 147, 138, 22 and 7 patients respectively. No untoward side effect was reported in any case. Variations in symptom score could be fully evaluated only in 80 of 320 patients (25%), of whom 68 (85%) reported a significant benefit, with special reference to an improvement of pain, urgency, strangury and nocturia. Data on variations in prostate volume, as measured by digital rectal examination, were available in 84 (26.5%) patients. No significant change was observed. Qmax after treatment was measured in 83 (26%) patients. It did not show significant changes from the initial values. DISCUSSION. The association tested in our study appeared to be safe and well tolerated. No changes in flow rate and prostate volume were observed, but a marked reduction of LUTS was observed in 85% of evaluable cases, especially with regard to pain and irritative symptoms. Whether or not such an association may display a prevention of prostate cancer, may be investigated in additional studies.

Introduction and Objective: Gynaecomastia is a potentially treatment limiting adverse event of antiandrogen monotherapy for prostate cancer. Tamoxifen has shown to be effective in therapy and prophylaxis of gynecomastia and breast pain. However, tamoxifene dosage and treatment duration are not established and debate still exists if prophylaxis is more effective than therapy at the early onset. This randomized study compared the prophylactic activity of tamoxifene at the dose of 10 mg with its therapeutic activity when given at the dose of 20 mg at the early appearance of gynecomastia in patients receiving bicalutamide 150 mg/d for prostate cancer. Methods: Between June 2005 and June 2007, 176 patients (median age 74 years), affected by prostate cancer have been randomized, at the moment of bicalutamide prescription, in to 2 arms according to gynecomastia treatment with tamoxifen. Arm A: Tamoxifen 20 mg/daily given for one year starting at the early onset of gynecomastia (within one month); tamoxifen 10 mg/daily given for one year starting at the prescription of bicalutamide. Routine laboratory exams, testosterone, PSA and follow-up visits were obtained at one month and then 3-monthly. Gynecomastia and breast pain were evaluated by the patients through a self-administered visual analog scale. Moreover, gynecomastia was classified into 4 grades (0-4) by physical examination. Results: At a follow-up between 3 and 24 months, gynecomastia increased in arm A from 34% at 3 months up to 78% after 12 months of bicalutamide therapy. When tamoxifen 20mg was given all patients showed gynecomastia and breast pain reduction, not vanishing, however, in 56% and 34% of cases respectively. Two patients interrupted the treatment after 3 months due to dizziness and 4 (5%) patients did not considered relevant the gynecomastia and did not take the drug. The incidence of gynecomastia and breast pain was significantly reduced (p