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Bagnara V, Giammusso B, Castagnetti M, Esposito C, Bianchi A. Distal hypospadias repair using the needle point bipolar cutting-coagulation forceps. J Pediatr Urol 2020; 16:69.e1-69.e5. [PMID: 31740147 DOI: 10.1016/j.jpurol.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To determine the outcome of distal hypospadias repairs performed using bipolar diathermy (BD) for all the dissection. METHODS Retrospective review of 310 patients undergoing distal hypospadias (264 subcoronal/distal penile and 46 coronal/glanular) over a 11-year period. Median age at surgery was 2.0 years (range 9 months-15 years). Caudal anesthesia was performed in all patients. All children underwent an in situ tubularization of the urethral plate, which was combined with midline incision of the plate in 30 (10%). Preputial reconstruction was performed in 303 (98%) patients. BD forceps was used for coagulation and for all the dissection including skin incision, elevation of glans wings, separation of the corpus spongiosum from the corpora cavernosa, and urethral plate incision, when deemed appropriate. The authors assessed surgical complications and cosmetic results. The latter using the hypospadias objective score (HOSE), with a score ≥ 14 considered as acceptable. RESULTS The average operative time was 70 min. There was no postoperative bleeding or hematomas that required surgical intervention. There were no wound infections or necrosis. Complications occurred in 37 patients (11.9%). Urethral fistula formation was the commonest (n = 18). Postoperative persistent preputial swelling occurred in 3.5% of cases. Two hundred twelve patients (90.6%) had a HOSE score ≥ 14, and no patient required revision surgery for skin problems after a median follow-up of 8.1 (range 1.2-13.1) years. DISCUSSION The study is limited by its retrospective nature and by the fact that a number of other pre-operative, intra-operative, and postoperative variables can affect outcome. CONCLUSIONS Bipolar diathermy can be safely used for distal hypospadias repairs. It allowed careful control of intra-operative bleeding and also clear visualization of tissue planes. Complication rate overall compares favorably with the literature, and cosmetic results were satisfactory.
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Affiliation(s)
- V Bagnara
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy.
| | - B Giammusso
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy
| | - M Castagnetti
- Section of Paediatric Urology, Department of Surgical, Oncological and Gastrointestinal Sciences, University Hospital of Padova, Padua, Italy
| | - C Esposito
- Paediatric Surgery Unit, University Hospital of Naples, Naples, Italy
| | - A Bianchi
- Specialist Paediatric Reconstructive Surgeon, Royal Manchester Children's Hospital, United Kingdom
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Cocci A, Russo G, Cito G, Falcone M, Polloni G, Serni S, Giammusso B, Verze P, Mondaini N. HP-09-003 Safety of collagenase clostridium hystolyticum in patients affected by Peyronie's Disease under anti-platelets or anti-coagulants. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cocci A, Russo G, Cito G, Verze P, Dachille G, Ditonno P, Di Modugno F, Giammusso B, Mondaini N. PS-05-006 How uncommon penile curvatures influence clinical outcomes in patients with Peyronie's Disease receiving collagenase clostridium hystolyticum therapy? J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Capece M, Cocci A, Russo G, Cito G, Giubilei G, Cacciamani G, Garaffa G, Falcone M, Timpano M, Tasso G, Sessa F, Campi R, Di Maida F, Cai T, Morelli G, Giammusso B, Verze P, Palmieri A, Ralph D, Mirone V, Mondaini N. Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study. Andrology 2018; 6:564-567. [PMID: 29733116 DOI: 10.1111/andr.12497] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/06/2018] [Accepted: 03/29/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M. Capece
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche; Universita degli Studi di Napoli Federico II; Napoli Italy
| | - A. Cocci
- Department of Urology; Azienda Ospedaliero Universitaria Careggi; Firenze Italy
| | - G. Russo
- Department of Urology; Universita degli Studi di Catania Scuola di Facolta di Medicina; Catania Italy
| | - G. Cito
- Department of Urology; Azienda Ospedaliero Universitaria Careggi; Firenze Italy
| | - G. Giubilei
- Department of Urology; Azienda USL Toscana centro Sede di Empoli; Empoli Italy
| | - G. Cacciamani
- Azienda Ospedaliera Universitaria Integrata Verona; Verona Italy
| | | | - M. Falcone
- Department of Urology; Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino; Torino Italy
| | - M. Timpano
- Department of Urology; Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino; Torino Italy
| | - G. Tasso
- Department of Urology; Azienda Ospedaliero Universitaria Careggi; Firenze Italy
| | - F. Sessa
- Department of Urology; Azienda Ospedaliero Universitaria Careggi; Firenze Italy
| | - R. Campi
- Department of Urology; Azienda Ospedaliero Universitaria Careggi; Firenze Italy
| | - F. Di Maida
- Department of Urology; Azienda Ospedaliero Universitaria Careggi; Firenze Italy
| | - T. Cai
- Department of Urology; Santa Chiara Hospital; Trento Italy
| | - G. Morelli
- Department of Urology; Università di Pisa; Pisa Italy
| | - B. Giammusso
- Department of Urology; Universita degli Studi di Catania Scuola di Facolta di Medicina; Catania Italy
| | - P. Verze
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche; Universita degli Studi di Napoli Federico II; Napoli Italy
| | - A. Palmieri
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche; Universita degli Studi di Napoli Federico II; Napoli Italy
| | - D. Ralph
- The Institute of Urology; London UK
| | - V. Mirone
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche; Universita degli Studi di Napoli Federico II; Napoli Italy
| | - N. Mondaini
- Department of Urology; Ospedale Santa Maria Annunziata; Bagno a Ripoli Italy
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Rago R, Gallo M, Dal Lago A, Licata E, Paciotti G, Amodei M, Meneghini C, Fabiani C, Dani G, Liberanome C, Antonaci D, Corno R, Miriello D, Giuffrida G, Giammusso B. Controlled, prospective, observational study on the efficiency and tolerability of a combination of potential Nrf2-inducing antioxidants and micronutrients as pre-treatment for ICSI in dyspermic patients with previous failure. Eur Rev Med Pharmacol Sci 2017; 21:1645-1652. [PMID: 28429340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the efficiency of pre-treatment in dyspermic males in IVF couples with a combination of micronutrients, for the purpose of improving the fertilization rate, the implantation rate and the outcome of the pregnancy. PATIENTS AND METHODS This controlled prospective clinical study was performed in two medically assisted reproduction centers. 59 males with mild oligo-astheno-teratospermia (OAT) were admitted to the study. All of them had a history of previous in vitro fertilization (IVF) attempts with female partners aged < 40 diagnosed having tubal or idiopathic infertility. The subjects upon enrolment underwent a semen test and afterward were treated with alpha lipoic acid and glutathione (Fertiplus SOD®, Idi-Pharma, Catania, Italy) for 4 weeks (short-term). The primary endpoints that were evaluated are the following: fertilization rate (mean fertilization), implantation rate and pregnancy rate. RESULTS At the end of this study all the males (mean age 39.5 ± 5.1) reported in not having any side effects during the administration of Fertiplus. Their female partners (mean age 34.9 ± 4.5) underwent IVF using the ICSI technique. The number of oocytes retrieved and inseminated was not statistically different in comparison to previous attempts, but with the same number of oocytes treated, the fertilization rate per couple demonstrated statistically significant increase (p<0.001). We did not observe a percentage increase in evolutionary embryos, but we noticed an improvement in embryo quality per individual couple (p<0.001), associated with a net increase in the implantation rate per couple (p<0.001) in terms of clinical pregnancy. The estimated miscarriage risk after treatment was five times lower (p<0.001). CONCLUSIONS Short-term treatment with micronutrients in dyspermic subjects can improve the reproductive outcome of the IVF procedure.
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Affiliation(s)
- R Rago
- Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy.
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La Vignera S, Calogero AE, Condorelli R, Lanzafame F, Giammusso B, Vicari E. Andrological characterization of the patient with diabetes mellitus. MINERVA ENDOCRINOL 2009; 34:1-9. [PMID: 19209124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM In the management of the chronic complications caused by diabetes mellitus, an important role is played to andrological problematics, which require a specialistic evaluation combined in order to concretely contribute to the improvement of quality of life of such patients. The erectile disfunction in the diabetic patient notoriously correlates with the main cardiometabolics risk factors, and recently it has been pointed out how after chronic use of inhibitors of the phospodiesterase-enzyme-5 (PDE5-I) it is possible to improve the vascular response profile, evaluated through ecolor doppler (ECD) penile dynamic. The incidence of the vascular extra-genital pathology in the patients with ED of organic arterial type has also been observed, underlining in particular the correlation with a low value of the systolic peak at penile level. Little attention has been paid to other andrologic pathologies that preliminary clinic evidences or less followed research points have individuated as real emerging problems; among them there are: 1) the hypogonadism in adult age (late onset hypogonadism); 2) the lower urinary tract symptoms (LUTS) correlated to the condition of prostatic hypertrophy; 3) the infections of the male genito-urinary tract with different characterization for imaging respect to the not diabetic population; 4) different sexual disorders; 5) implications over the male reproductive sphere. METHODS Retrospective analysis of the clinic, laboratory (spermatic, microbiologic and hormonal), ultrasonography integrated data, led on a diabetic population examined during the last 3 years; finalized at the estimation of the distribution of the andrological pathology characterizing such population, with the comparison of the data on the basis of years of duration disease, grade of glicometabolic compensation and levels of total testosterone. RESULTS ED was present in 16.36% of the examined population; 50% showed vascular arterial form; hypogonadism was present in 10% of the population. A very high prevalence of subfertility was observed 51.82%. The ultrasonographic characterization of the didimo-epididimary and prostatic-vesicular regions showed reduced testicular volume the 16.36% of cases, increase of the prostatic glandular volume in 45.45% of cases, altered thickness of the seminal vesicles in the 24.45% of cases. The microbiologic characterization evidences the contemporary positivity of the 3 prechosen indicators (spermiocolture, urinocolture, leukocytospermia) in 34.55% of patients. CONCLUSIONS The study has contributed to enrich the data relative to the heterogeneity of the clinic-andrological presentation of the diabetic patient.
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Affiliation(s)
- S La Vignera
- Endocrinology Section, Andrology and Internal Medicine, Biomedical Science Department, Garibaldi Hospital (Centre), University of Catania, Catania, Italy.
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La Vignera S, Calogero AE, D'Agata R, Di Mauro M, Tumino S, Condorelli R, Lanzafame F, Finocchiaro C, Giammusso B, Vicari E. Testosterone therapy improves the clinical response to conventional treatment for male patients with metabolic syndrome associated to late onset hypogonadism. MINERVA ENDOCRINOL 2008; 33:159-167. [PMID: 18846023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM Recently, the clinic characterization of the gonadic male function has been put in tight correlation on the pathogenetic level with the main variables forming the condition of metabolic syndrome (MS); probably the serum testosterone (T) concentration in males is to be considered as an additional parameter completely related to the traditional clinical-metabolic findings. Currently the matter of the substitutive hormonal therapy with androgens is apparently influenced by some important unresolved aspects: 1) who really benefits from the T therapy? 2) are the actual dosage methods of T reliable? 3) which vascular and metabolic targets are to be monitored during the T therapy? METHODS In an analytical longitudinal study, carried out 12 months long on 60 men (average age 58 years, range 54-63 years) affected by metabolic syndrome (MS) and combined hypogonadism late onset (LOH), authors have evaluated the clinical response (androgenic asset, non-invasive hospital monitoring of the arterial pressure, lipidic asset study, body composition and the biologic resistance to the insulinic action) after conventional medical therapy (insulin-sensibilizing and anti-hypertensive) and after substitutive hormonal therapy with testosterone (T) by transdermic way. A group of five patients with MS and LOH, not treated, was used as group of control. RESULTS The group of patients treated with T showed a profile of clinical response better than the group of controls. CONCLUSIONS In conclusion, the seric determination of T is useful to better characterize the dismetabolic patient at the moment of the first level active medical therapy planning on the controls of the main risk factors constituting MS, expressing a potential role of conditioning.
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Affiliation(s)
- S La Vignera
- Endocrinology, Andrology and Internal Medicine Unit, Department of Biomedic Scieces, University of Catania, Garibaldi Hospital, Catania, Italy.
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La Vignera S, Calogero AE, Castiglione R, D'Agata R, Giammusso B, Condorelli R, Vicari E. IL-6, TNFalfa, IL-10 in the seminal plasma of patients with bacterial male accessory gland infections after sequential therapy. MINERVA UROL NEFROL 2008; 60:141-145. [PMID: 18787508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM In previous studies the authors have demonstrated a worse spermatic outcome associated to overproduction of ROS in infertile patients with urogenital infections extended to more glands (prostato-vesciculitis, PV) compared to what observed in patients with prostatitis (P) (cat II according to the National Institutes of Health [NIH]). Among the reasons of an inadequate post-therapeutical response, the duration of each therapeutical phase could be the only bias of empirism entrusted only to the monitoring of obvious ''traditional'' end-points, resulting underrated for various reasons (costs, lacking methodological standardization, choice of the cytokines to be monitored). The evaluation of other therapeutical endpoints (cytokine dosage in the seminal plasma; analysis of ROS) is therefore all important. METHODS In order to evaluate how to optimize the therapeutic response in infertile patients with P o PV chronic-bacterial, the authors wanted to monitor the pattern of the pro-oxidants cytokines TNFalfa, IL-6 in the seminal plasma (met. sandwich ELISA high sensitivity <0.039 pg/mL, R&D System Europe Ltd, UK) and of IL-10 (chosen as antioxidant cytokine) after sequential therapy (antibiotic - non-steroidal anti-inflammatory drugs antioxidant). RESULTS AND CONCLUSIONS The modifications of the levels of TNFalfa, IL-6 ed IL-10 recorded in the present study during the sequential therapy for P or PV microbic offer some issues for reflection for interesting clinical-diagnostical implications: 1) possible revision of sequences and/or duration of the therapeutical phases in course of PV; and 2) the role to assign to the IL-10 (assumed as anti-inflammatory cytokine).
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Affiliation(s)
- S La Vignera
- Endocrinology Section, Andrology and Internal Medicine, Biomedical Science Department, Garibaldi Hospital (Centre), University of Catania, Catania, Italy.
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10
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Pescatori E, Giammusso B, Gentile V, Pirozzi Farina F. Male sexual distress: from definition to clinical approach. Sexologies 2008. [DOI: 10.1016/s1158-1360(08)72601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pecoraro S, Fienga A, Giammusso B. VID-05.02: Three piece penile prosthesis implant (Titan® with Resist®) in complex cases. Urology 2007. [DOI: 10.1016/j.urology.2007.06.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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La Vignera S, Calogero AE, Condorelli R, Giammusso B, Vicari E. [Partial androgen deficiency of the aging male and clinical response to conventional medical therapy in patients with metabolic syndrome]. Minerva Med 2007; 98:101-7. [PMID: 17519852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIM Analytical study (longitudinal) able to examine the modifications relative to some of the main metabolic parameters: body mass index (BMI); waist measurement; cholesterol HDL; triglicerydes, medium arterial pressure and some insulin sensitivity indicators deduced (index HOMA and index Quicki) in patients with full clinical expression of metabolic syndrome (SM) and comparison of the results in relation to the condition of testosteronemia. METHODS Fifty-six male patients aged between 52 and 59 years old; 23/56 with full expression of SM, assignable (SM) to 3 different groups: group A n=8 (35%) with T normal (>346 ng/dL); group B n=9 (39%) with values of T at low limits (231-346 ng/dL); group C, n=6 (26%) with low values(<231 ng/dL) of T. All patients (SM) were subjected to an educational-therapeutic phase of 6 months divided into 3 intervention levels: 1) dietotherapy: -20% from the ideal daily caloric needs calculated on the base of parameters such as: age, working activity, physical activity performed; 2) physical activity: heart rate (HR) included between 40% and 60% of the HRmax; three times a week; 3) pharmacological therapy: metmorfin 1 500 mg/die and olmesartan 20 mg/die. The condition of hypoandrogenism (group C) was not pharmacologically corrected for: a) lack of suitability to the therapeutic scheme (2/6); b) presence of controindications absolute and/or relative (4/6). Revaluation in 6 months: BMI, waist measurement, serum levels of cholesterol HDL and triglicerydes, glycemia, medium arterial pressure, HOMA, Quicki, total testosteronemia. RESULTS Group C (hypoandrogenism) after 6 months shows statistically significant differences (Student's T for coupled data), down (P<0.05) relative to the following parameters (intragroup comparison): waist measurement and serum levels of triglycerides. On the contrary, it doesn't show any significant difference regarding: BMI, serum levels of cholesterol HDL, mean arterial pressure, HOMA index (found in groups A and B) and Quicki (not found in groups A and B). CONCLUSION The condition of acquired hypoandrogenism of the adult serves as an amplifier of an already known condition of dysmetabolism. The same condition, when not properly pharmacologically corrected becomes responsible for refractoriness to the common pharmacological therapies.
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Affiliation(s)
- S La Vignera
- Sezione di Endocrinologia, Andrologia e Medicina Interna, Dipartimento di Scienze Biomediche, Ospedale Garibaldi, Università degli Studi di Catania, Catania, Italy.
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Giammusso B, Pomara G, Giannarini G, Motta M. Ninth commandment: 'Thou shalt not covet thy neighbor's wife!' Penetrating trauma to the corpora cavernosa caused by gunshot. Int J Impot Res 2006; 18:566-7. [PMID: 16598300 DOI: 10.1038/sj.ijir.3901472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe a case of gunshot wound to the corpora cavernosa caused by a low-velocity bullet in a 43-year-old man. He volunteered that his lover's husband shot him with a handgun. The bullet had penetrated the right gluteal region with no exit wound causing a right corpus cavernosum lesion. A penile colour-duplex doppler ultrasonography did not reveal injuries of the cavernosal arteries or altered peak diastolic and systolic values. A three-dimensional computed tomography study corfirmed the presence of the bullet at the root of the right corpus cavernosum and allowed to identify the curvilinear ballistic trajectory, confirming a low-velocity penetrating bullet. The patient underwent exploratory surgery with removal of the bullet and primary repair of the identified unilateral albuginea rupture. The bullet, passing through clothing, probably slowed down causing less than expected harm. The follow-up visit after 2 months showed that the penile girth was not narrowed by such a repair. With a 2-year follow-up the patient has a normal penile ultrasound morphology and a normal sexual activity.
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Affiliation(s)
- B Giammusso
- Department of Urology, Vittorio Emanuele Hospital, University of Catania, Catania, Italy
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Giammusso B, Raffaele R, Vecchio I, Giammona G, Ruggieri M, Nicoletti G, Malaguarnera M, Rampello L, Nicoletti F. Sildenafil in the treatment of erectile dysfunction in elderly depressed patients with idiopathic Parkinson's disease. Arch Gerontol Geriatr 2005; 8:157-63. [PMID: 14764387 DOI: 10.1016/s0167-4943(02)00124-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- B Giammusso
- Department of Urology, University of Catania, Ospedale Vittorio Emanuele, Italy
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Vicari E, Barone N, La Vignera S, Battiato C, Salemi M, Castiglione R, Giammusso B. [Unilateral testicular cancer: incidence and effects of a contralateral testiculopathy on the sperm output]. MINERVA UROL NEFROL 2005; 57:47-52. [PMID: 15944521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM The aim of this paper was to evaluate the incidence of a non-tumoral, contralateral primitive testiculopathy and its relative influence on sperm quality of patients with unilateral testicular cancer. METHODS Twenty-four patients (mean age 26 years, range 19-38) with testicular germ cell cancer (seminomas, SEM, in 10 cases; nonseminomas, NSEM, in the remaining 14 patients) after orchiectomy and before radiotherapy or chemotherapy underwent semen analysis, physical examination and scrotal ultrasound of their survivor testis. RESULTS Patients with SEM had sperm concentration, total sperm count and forward motility significantly higher than those found in patients with NSEM. Altogether, 5 out of 24 patients (2 SEM; 3 NSEM) (20.8%) showed azoospermia; 10 patients (41.7%) (3 SEM; 7 NSEM) had oligo-, astheno- and/or terato-zoospermia (OAT). The remaining 9 patients (37.5%) (5 SEM; 4 NSEM) showed normal sperm parameters. The testicular volume of the left over testis was reduced (<12 ml) in 4 out of 5 (80%) azoospermic patients, in 7 out of 10 patients (70%) of OAT patients, but in no patient (0%) with normozoospermia. A testicular biopsy performed on the survivor testis of 5 patients with azoospermia (4 of them had a reduced testicular volume) confirmed the primitive testiculopathy, showing a histological pattern of Sertoli cell syndrome only in 4 of them (80%) and maturation arrest in the other case (20%). CONCLUSIONS Less (OAT) or more severe (azoospermia) sperm output impairment in patients with unilateral testicular cancer is associated with a coincidental, contralateral to unilateral testicular cancer, primitive testiculopathy expressed as reduced testicular volume and impairment spermatogenesis at the testicular biopsy.
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Affiliation(s)
- E Vicari
- Sezione di Endocrinologia, Andrologia e Medicina Interna, Dipartimento di Scienze Bio-Mediche, Università degli Studi di Catania, Catania, Italy.
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Falsaperla M, Morgia G, Giammusso B, Condorelli SV, Saita A, Marchese F, Spampinato A, Motta M. Role of Ca 15-3 in patients with biochemically suspected prostate cancer and multiple negative ultrasound-guided prostate biopsies. Prostate Cancer Prostatic Dis 2003; 6:45-9. [PMID: 12664064 DOI: 10.1038/sj.pcan.4500615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2001] [Revised: 06/21/2002] [Accepted: 07/03/2002] [Indexed: 11/09/2022]
Abstract
Ca 15-3 is an aspecific tumor marker characteristic of cancer proliferation. Elevated serum levels seem to be closely correlated with cancer progression in non-urological tumors. This study assessed the role of Ca 15-3 as an aspecific tumor marker in patients with borderline prostate-specific antigen (PSA) biochemically suspected of prostate cancer (PCa) and with multiple negative prostate biopsies. The study is based on prospective analysis of 103 patients: (a) 33 patients (group A) presented lower urinary tract symptoms secondary to BPH with normal serum PSA values, DRE and TRUS negative for suspected PCa; (b) 31 patients (group B) with histologically diagnosed PCa; (c) 39 patients (group C) with borderline serum PSA values, DRE and TRUS normal, two ultrasound (US)-guided random prostate biopsies negative for PCa. Ca 15-3 was determined in the entire study series by the IRMA method, using as range the values proposed for the investigated non-urological tumors (38 UI/l).Ca 15-3 was within normal range in all group A patients (control), while the values were elevated in 27/31 of group B patients (PCa) and in 11/39 of group C (PCa suspected) patients. A third biopsy was performed in all 39 group C patients with borderline PSA and it was PCa-positive in 13 patients (33.3%, subgroup C3). In this series Ca 15-3 was increased in 9 of 13 patients (subgroup C3alpha), while the remaining four patients (subgroup C3beta) presented values within the normal range. On 26 group C patients who were negative for PCa to third biopsy (subgroup C4), 24 patients had Ca 15-3 levels within normal range (subgroup C4alpha) with histologic findings of BPH in 23 cases and granulomatous chronic prostatitis in one case, while two patients (subgroup C4beta) had elevated Ca 15-3 concentrations associated with lymphoplasmacytic chronic prostatitis. We hypothesize that Ca 15-3, as a specific tumor marker, could be an interesting and inexpensive second step diagnostic tool for PCa in patients with borderline PSA and multiple negative prostate biopsies, as it could indicate whether a repeated biopsy should be performed in a short time, having excluded other concomitant tumors. However, further prospective studies will be necessary to confirm this hypothesis.
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Affiliation(s)
- M Falsaperla
- Department of Urology II, University Of Catania, Catania, Italy
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Raffaele R, Vecchio I, Giammusso B, Morgia G, Brunetto MB, Rampello L. Efficacy and safety of fixed-dose oral sildenafil in the treatment of sexual dysfunction in depressed patients with idiopathic Parkinson's disease. Eur Urol 2002; 41:382-6. [PMID: 12074807 DOI: 10.1016/s0302-2838(02)00054-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE AND METHODS The efficacy and safety of oral Sildenafil, a potent inhibitor of phosphodiesterase type 5, were evaluated in depressed men with idiopathic Parkinson's disease and erectile dysfunction. Thirty-three men were enrolled in a 4-month prospective, open-label, fixed-dose study, and received 50mg of Sildenafil in the home setting approximately 1 hour before sexual activity, not more than once daily. Efficacy was determined by responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) of the 15-item International Index of Erectile Function (IIEF). Other measures of efficacy included the five sexual function domains of IIEF, a global efficacy question, the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale-21 (HDRS-21). RESULTS At the end of the study, improved erections were reported by 84.8% of patients. Sildenafil significantly increased patients' ability to achieve and maintain erections. Significant improvements were also observed in the IIEF domains for erectile function, orgasmic function, intercourse satisfaction and overall sexual satisfaction. BDI and HDRS scores improved from baseline to the end of the study. A clear improvement of depressive symptoms was observed in 75% of patients. Sildenafil was well tolerated in all the patients. CONCLUSIONS Treatment with oral Sildenafil improves erectile function and, indirectly, depressive symptoms in patients with idiopathic Parkinson's disease stages 1-3, and is well tolerated.
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Affiliation(s)
- R Raffaele
- Department of Neurosciences, University of Catania, Catania, Italy
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Saita A, Morgia G, Branchina A, Giammusso B, Iurato C, Malacasa E, Motta M. [Mepartricine and prostatitis. Clinical experience and rationale for use]. MINERVA UROL NEFROL 2001; 53:129-33. [PMID: 11723437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The purpose of this study was to report our experience on the use of Mepartricine in the treatment of chronic and sub-acute prostatitis and to analyse, on the basis of the literature, the role of estrogens, the target of Mepartricine in the development and maintenance of prostatic inflammatory reactions. METHODS In a retrospective study the data of 110 patients who presented with lower urinary tract symptoms suggestive of prostatitis, from January 1994 to February 1999 have been evaluated: 65 of this patients had an abacterial prostatitis, and 45 a bacterial prostatitis. The Mearers-Stamey test was used to localize inflammation and pathogens to prostate. The clinical symptoms presented were essentially pelvic and perineal pain and irritative and obstructive voiding symptoms. The treatment was based on antibiotic therapy indicated by the sensitivity to antibiotic assay. In abacterial prostatitis, in cases of Chlamidia, Mycoplasma and Ureaplasma positivity, the treatment was based on macrolides and tetracycline use. All the patients received Mepartricine by oral supply, 1 daily tablet (40 mg) for 60 days. RESULTS After two months of treatment remarkable improvements in symptoms were obtained despite the persistent bacteriological positivity in the prostatic secretion in 68% of cases. Therefore antinflammatory antiedemic and decongestant effects of Mepartricine on prostatic inflammation, are observed. CONCLUSIONS The data of the literature show data estrogens modulate inflammatory reactions: it is possible that their decrease can produce, at prostatic level, antinflammatory effects improving urethro-prostatic bladder functions. Personal experience seems to confirm this supposition and so we think that Mepartri-cine can be considered and excellent coadjuvant in the treatment of prostate inflammation, independent of etiology.
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Affiliation(s)
- A Saita
- Divisione Clinicizzata di Nefrologia Chirurgica-Urologia, Università degli Studi, Catania, Italy
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Lombardo T, Giammusso B, Frontini V, D'Arpa S, Pafumi C, Caruso S. Thalassaemic men affected by erectile dysfunction treated with transurethral alprostadil: case report. Hum Reprod 2000; 15:2375-8. [PMID: 11056136 DOI: 10.1093/humrep/15.11.2375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of this controlled clinical study, performed in a specialized institutional unit for thalassaemic men, was to consider the possibility of restoring erection in beta-thalassaemic patients with erectile dysfunction by administering E(1) prostaglandins (alprostadil) transurethrally. Four patients affected by beta-thalassaemia, aged between 32 and 52 years, and having an erectile dysfunction were included in the study. Each patient was given 500 microg alprostadil in the distal urethra. Response was evaluated by the erection assessment scale. The main outcome measures were: (i) the clinical study; (ii) FSH, LH, total and free testosterone plasma concentrations; and (iii) basal and dynamic Doppler sonography of cavernous arteries. The treatment produced a response of 3-4 on the erection assessment scale. Average minimum response time was 20 min, while average maximum response time was about 60 min. There was no evidence of significant side effects. Our hypothesis is that the delayed reaction was due to organ damage induced by iron load, causing a reduction or absence of elasticity in the interstitial tissue of the corpora cavernosa. Thus, we believe that treatment with alprostadil can be considered an effective, non-invasive therapy for thalassaemic patients with erectile dysfunction.
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Affiliation(s)
- T Lombardo
- Division of Thalassaemia and Department of Microbiological Science and Gynaecological Science, Ospedale S.Bambino, Catania
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Montorsi F, Rigatti P, Carmignani G, Corbu C, Campo B, Ordesi G, Breda G, Silvestre P, Giammusso B, Morgia G, Graziottin A. AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients. Eur Urol 2000; 37:50-5. [PMID: 10671785 DOI: 10.1159/000020099] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions. METHODS Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively questioned about function of the device and its impact on the couple's sexual life. RESULTS At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders. CONCLUSIONS AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.
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Affiliation(s)
- F Montorsi
- Divisione di Urologia, Ospedale San Raffaele, Milano, Italia.
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21
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Di Grazia E, Morgia G, Fondacaro L, Saita A, Costantino C, Giammusso B, Spampinato A, Motta M. Use of heterologous collagen: Our experience. Urologia 1997. [DOI: 10.1177/039156039706400433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
– The use of bovine collagen cross-linked with glutaraldehyde microspheres is considered a good procedure in the treatment of incontinence caused by ISD. Its widespread use is due to the absence of toxicity, easiness of injection and lack of invasiveness. On the other hand its high cost and lack of long-term efficacy has to be considered. The authors report their preliminary experience in using collagen GAX to treat 5 women with ISD, 2 with recurrent SUI and 2 with vesico-vaginal fistulas. Although an unusual treatment for the latter, it could be considered as an alternative mini-invasive tool in these pathologies. The results were as follows: in the patients with ISD, 3 were cured (42.8%) and 2 improved (28.5%), while the 2 SUI patients remained the same (28.5%). Treatment of the vesico-vaginal fistulas was unsuccessful.
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Affiliation(s)
- E. Di Grazia
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
| | - G. Morgia
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
| | - L. Fondacaro
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
| | - A. Saita
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
| | - C. Costantino
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
| | - B. Giammusso
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
| | - A. Spampinato
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
| | - M. Motta
- Dipartimento di Chirurgia - Sezione di Nefrologia Chirurgica ed Urologia - Università degli Studi - Catania 14° Congresso della Società Siculo-Calabra di Urologia - Marsala, 3–5 ottobre 1996 - Comunicazione
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Giammusso B, Morgia G, Spampinato A, Motta M. [Paroxetine in the treatment of premature ejaculation]. Arch Ital Urol Androl 1997; 69:11-3. [PMID: 9181900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study evaluated paroxetine as a possible treatment for premature ejaculation. Sixty two patients affected by primary premature ejaculation were randomly assigned to two groups. A and B, and treated with two different treatment schedules. Patients assigned to group A were treated with paroxetine 20 mg p.o. daily for six months; patients assigned to group B were treated with paroxetine 20 mg p.o. daily for fourteen days, and than dose was reduced to 10 mg for a total treatment period of six months. Only one patient reported significative side effects (weakness). Positive clinical results were obtained, at the end of the treatment, in 89 per cent of group A and 88 per cent of group B. In patients with primary premature ejaculation, paroxetine represents, in our opinion, the best therapeutic option for its efficacy and lack of significant side effects.
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Affiliation(s)
- B Giammusso
- Dipartimento di Chirurgia, Università di Catania
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Morgia G, Saita A, Fondacaro L, Giammusso B, Motta M. Pilot study with combined alfuzosin + finasteride in BPH treatment. Urologia 1995. [DOI: 10.1177/039156039506200214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Today there are many types of therapies (medical and surgical) in BPH treatment. The Authors suggest dividing BPH into two components: a dynamic phase and a static phase. On the basis of this, they used an association of finasteride and alfuzosin in short and long-term therapy. Provided the rationale is correct, the results in terms of improved flow and symptomatology score suggest that this is an optimal solution.
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Affiliation(s)
- G. Morgia
- Department of Urologic Pathology and Aging - Chair of Urology - Unit of Nephrologic surgery - University of Catania
| | - A. Saita
- Department of Urologic Pathology and Aging - Chair of Urology - Unit of Nephrologic surgery - University of Catania
| | - L. Fondacaro
- Department of Urologic Pathology and Aging - Chair of Urology - Unit of Nephrologic surgery - University of Catania
| | - B. Giammusso
- Department of Urologic Pathology and Aging - Chair of Urology - Unit of Nephrologic surgery - University of Catania
| | - M. Motta
- Department of Urologic Pathology and Aging - Chair of Urology - Unit of Nephrologic surgery - University of Catania
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Garufi A, Priolo GD, Coppolino F, Giammusso B, Materazzo S. [Computed tomography evaluation of urothelial carcinomas of the upper urinary tract]. Radiol Med 1993; 86:489-95. [PMID: 8248587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Computed Tomography (CT) is an indispensable noninvasive method for staging transitional cell carcinomas of renal pelvis and ureter. Twenty-seven patients with upper urinary tract tumors were examined and the CT results correlated with histopathologic findings. These tumors exhibit three different development patterns: in our series we identified 17 intraluminal sessile lesions, 6 focal or concentric wall thickenings and finally 7 infiltrating masses; soft-tissue density lesions exhibited in all cases mild contrast enhancement (mean density increase: 38 HU). Even though the attenuation values of tumors do not allow the accurate demonstration of the depth of renal pelvis and ureteral wall invasion, CT can differentiate the lesions which are still confined within the external wall layers (CT1, 17 cases) from those invading the peripelvic-ureteral fat (CT2, 9 cases) or spreading to other organs as well as distant metastases (CT3, 4 cases). Delayed scans can also demonstrate intraluminal lesion extent and sometimes changes of patients' position allow better differentiation of wall outlines from peripheral fat. The overall staging accuracy of CT was 76.66% and its sensitivity was 93.33%. The assessment of lymph node metastases was the major cause of error in the CT evaluation of these tumors.
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Affiliation(s)
- A Garufi
- Cattedra di Radiologia Generale e Speciale Odontostomatologica, Università di Catania
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Morgia G, Costanzo V, Giammusso B, Fondacaro L, Motta M. [Uroflowmetry in the early diagnosis of postoperative urethral stenosis]. MINERVA UROL NEFROL 1992; 44:173-6. [PMID: 1492267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Uroflowmetry is a widely used technique for evaluation of lower urinary tract "obstructions", and urethral strictures (US) are considered a typically late complication after endoscopic or open prostatectomy. The clinical experience of the Department of Urology of Catania University is reported. Uroflowmetry was included in routine checks of prostatic patients after operation (TUR or open surgery) and the tests were performed at 40 and 180 days post-operatively. This proved to be an effective and objective means for early diagnosis of urethral strictures.
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Affiliation(s)
- G Morgia
- Cattedra di Urologia Ginecologica, Università degli Studi di Catania
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26
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Morgia G, Costantino G, Nicosia A, Giammusso B, Motta M. Extracorporeal shock wave lithotripsy for urinary stone disease: our experience. Arch Ital Urol Nefrol Androl 1992; 64:183-6. [PMID: 1509273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The authors report results of an 18 month study on ESWL treatment for calculosis of different tracts of the urinary apparatus. Average success rate is 80%, even if it varies depending on the site and size of the calculus. Surgery and PCN are required only in cases of unsuccessful treatment or particular forms of lithiasis. ESWL has determined advanced in the treatment of renoureteral stones in the last decade. However some significant generalized complications observed in our patients at follow-up raise doubts concerning possible, unforeseable long term effects of ESWL treatment.
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Affiliation(s)
- G Morgia
- Chair of Surgical Nephrology, University of Catania
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