Sexual Activity and Urinary Incontinence in Women

Urinary incontinence during sexual intercourse refers to overactive bladder (OAB) syndrome and it is divided in incontinence during penetration and during orgasm. 480 women with low urinary tract symptoms (LUTS) were divided in a) affected by probable genuine stress incontinence, b) probable Urge-stress incontinence, c) probable Urge Incontinence, to specify incidence.

Materials and Methods

In Group C (186 women) 36 women, age range 24 to 56 years, with urinary incontinence only during sexual intercourse, were selected: 16 during orgasm (group I), 20 during penetration (group II). These patients filled in specific validated questionnaires (ICI-9), urinary recordings and, after urine exam, they underwent US study of urinary tract with post-micturition evaluation. The patients with other urological diseases or pelvic prolapse in stage II of POP-Q or higher were excluded. Patients were referred to physiatric evaluation and urodynamic exam with cystomanometry and perineal EMG, with provocative tests and after pressure-flow study.

Results

Cystocele was found in 4 out of 16 women in Group I, and in 6 out of 20 in Group II. No patients showed basic detrusor hyperactivity during cystomanometry. In Group I: 50% had detrusor hyperactivity and 18.75% had prolonged perineal relaxation. In Group II 30% had detrusor hyperactivity and 35% had prolonged perineal deficit. Results suggest parasympathetic deficiency in Group I and sympathetic deficiency in Group II.

Oxidative stress, glutathione status, sirtuin and cellular stress response in type 2 diabetes

Oxidative stress has been suggested to play a main role in the pathogenesis of type 2 diabetes mellitus and its complications. As a consequence of this increased oxidative status a cellular adaptive response occurs requiring functional chaperones, antioxidant production and protein degradation. This study was designed to evaluate systemic oxidative stress and cellular stress response in patients suffering from type 2 diabetes and in age-matched healthy subjects. Systemic oxidative stress has been evaluated by measuring plasma reduced and oxidized glutathione, as well as pentosidine, protein carbonyls lipid oxidation products 4-hydroxy-2-nonenal and F2-isoprostanes in plasma, and lymphocytes, whereas the lymphocyte levels of the heat shock proteins (HSP) HO-1, Hsp72, Sirtuin-1, Sirtuin-2 and thioredoxin reductase-1 (TrxR-1) have been measured to evaluate the systemic cellular stress response. Plasma GSH/GSSG showed a significant decrease in type 2 diabetes as compared to control group, associated with increased pentosidine, F2-isoprostanes, carbonyls and HNE levels. In addition, lymphocyte levels of HO-1, Hsp70, Trx and TrxR-1 (P<0.05 and P<0.01) in diabetic patients were higher than in normal subjects, while sirtuin-1 and sirtuin-2 protein was significantly decreased (p<0.05). In conclusion, patients affected by type 2 diabetes are under condition of systemic oxidative stress and, although the relevance of downregulation in sirtuin signal has to be fully understood, however induction of HSPs and thioredoxin protein system represent a maintained response in counteracting systemic pro-oxidant status. This article is part of a Special Issue entitled: Antioxidants and Antioxidant Treatment in Disease.

Efficacy of Dutasteride, Alfuzosin or both on Quality of Life in Patients with Prostatic Hyperplasia and BOO. A Two-Year Spontaneous, Observational, Self-Controlled Study

Three homogeneous groups of patients suffering from benign prostatic hypertrophy (BPH) were evaluated by means of a two-year observational study, in order to assess and compare their Quality of Life (QoL) under the following different medical treatments. Group 1: alfuzosin alone, Group 2: alfuzosin and dutasteride, Group 3: dutasteride alone. QoL was evaluated by validated indexes, such as the IPSS and the QoL-Vas.

Although different in entity and timing, as expected, all the three groups showed an improvement. The best and quickest results were detected in the drug association of Group 2. Significant decrease in volume was detected in the dutasteride groups (2 and 3) but not in group 1 (alfuzosin alone), where a quick relief of LUTS was detected, due to its well-known alphalytic action. Our results suggest that dutasteride alone does not result in a rapid decrease in LUTS, whereas it can help to manage the reduction of the prostate volume. A combination therapy seems therefore to be recommended to obtain LUTS relief both in the short and long term results.

[Efficacy of dutasteride, alfuzosin or both on Quality of Life in patients with prostatic hyperplasia and BOO.A two-year spontaneous, observational, self-controlled study]

Three homogeneous groups of patients suffering from benign prostatic hypertrophy (BPH) were evaluated by means of a two-year observational study, in order to assess and compare their Quality of Life (QoL) under the following different medical treatments. Group 1: alfuzosin alone, Group 2: alfuzosin and dutasteride, Group 3: dutasteride alone. QoL was evaluated by validated indexes, such as the IPSS and the QoL-Vas. Although different in entity and timing, as expected, all the three groups showed an improvement. The best and quickest results were detected in the drug association of Group 2. Significant decrease in volume was detected in the dutasteride groups (2 and 3) but not in group 1 (alfuzosin alone), where a quick relief of LUTS was detected, due to its wellknown alphalytic action. Our results suggest that dutasteride alone does not result in a rapid decrease in LUTS, whereas it can help to manage the reduction of the prostate volume. A combination therapy seems therefore to be recommended to obtain LUTS relief both in the short and long term results.

Blind Traumas of the Scrotum: Three Case Reports

The blind traumas of the scrotum are an uncommon event; references, iconography and descriptions of the clinical development of scrotal syndromes are poor. The scrotum and the didimal or funicular structures are often involved in different conditions. The authors are reporting on three interesting cases (for patients’ age, mechanism of traumatism and anatomic damage), gathered from a series of 12 cases of blind traumas of the scrotum, observed during 2 years (2005–2006). They include the iconography related to each single case, and emphasize the uncertain role of ultrasonography with color Doppler for a correct diagnosis.

The clinical evolution and the long-term damage to gonad functionality are presented.

[Primary hyperoxaluria and pregnancy]

A rare case of pregnancy in a patient with primary hyperoxaluria type 1 is reported offering a clinical contribution for the prognostic study of a natural event such as the pregnancy on these patients. It is underlined how epicriticity of the hepatorenal system is remarkably altered during the last weeks of pregnancy with a great increase of calciuria and proteinuria with a risk of life for the patient and the newborn. In fact, during the 36rd week a caesarean section was performed due to gestosis. Moreover, the deterioration of kidney functionality doesn't decrease during post partum. Therefore, it would be advisable inform these patients about the risk of pregnancy.

Disorders of micturition in neurological patients. A clinical study of 786 patients

Our aim was to evaluate the utility and effectiveness of a study protocol for neurological involvement in neurological disorders. We studied a sample of 786 patients with neurological disorders followed by the Neurological Department of Catania University and applied to them a four-step diagnostic protocol. Fifty-six per cent of the sample showed urological functional abnormalities; only 78 patients (9.9%) presented with an organic urological disease. Among the vesicosphincteric dysfunctions, bladder hyperreflexia was the most common pattern with remarkable differences between diseases. The present study demonstrated the utility of a standardized urological protocol in the screening and detection of neurological involvement in neurological diseases. Our protocol showed good specificity and reasonable low costs.

Physiokinesitherapy in the treatment of female stress incontinence

The authors report the results of treatment with physiokinesitherapy (PKT) in 36 women with stress incontinence (29 with genuine-stress incontinence and 7 with urge-stress incontinence). The therapeutic programme consisted of twelve 30-minute sessions, in which biofeedback was alternated with functional electric stimulation. Clinical evaluation included a self-assessment questionnaire, a physiatric visit and a urodynamic examination at 6 and 12 months after treatment. At the end of the PKT cycle, approx. 92% of patients had improved or recovered. After 6 months, however, 53% of patients had recovered, 33% had improved and 14% were stationary. After 12 months, in the 29 patients with genuine-stress incontinence, 66% had recovered, 24% had improved and 3% were stationary, while none of the patients with urge-stress incontinence had recovered (72% improved, 28% stationary). Our study confirms that PKT is helpful in treating urinary stress incontinence in women.

Detrusorial areflexia secondary to nodous periarteritis. Case report

– A boy with periarteritis nodosa (PAN) came to our department for urodynamic evaluation. The various cystomanometric tests gave alternating areflexic and hyperreflexic pictures. It is advisable in such cases for the neurourologist to follow a clinical screening protocol combined with a “self-oversee” supervision by members of the patient's family.

Therapeutic effect of TRH. T on 26 patients with myelopathy. Neurophysiatric and urological results

TRH.T is a tripeptide functioning as neurotransmitter which aids catecholamine, and especially norepinephrine, release. The neuromodulator action of TRH.T suggests that it could be helpful in the therapy of vesico-sphincteric dysfunctions. 26 patients with myelopathy were treated with TRH.T. The results show an improvement in both the neurological and urological picture. It would also seem possible that TRH.T could play an important role as a neurotransmitter and neuromodulator rather than a receptor-effector, especially in the lower urinary tract.

A structurally abnormal chromosome (46,XX,?17p+) associated with mental deficiency and congenital malformations

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48,XXXX-49,XXXXX mosaic: asynchronies among the late-replicating X chromosomes

A 13-year-old girl selected for chromosome investigations because of mental deficiency and multiple malformations was found to be a 48, XXXX/ 49, XXXXX mosaic. Multiple sex chromatin bodies, up to four, were found in oral mucosa smears and in cultured fibroblasts. Two cells with drumsticks were found in scoring 1,000 granulocytes. Autoradiography revealed cells with three and with four late-replicating X chromosomes. Analysis of the patterns of replication along the individual late-replicating X chromosomes in each cell revealed a certain degree of asynchrony among them. In both types of cells, with four and five X’s, the long arms of the X were the last to terminate synthesis. In the occasional cell there was marked internal asynchrony in this respect.

[The syndrome of the deletion of the short arm of a chromosome 4-5]

During routine karyotypic analysis of patients with mental deficiency and congenital malformations, a partial deletion of the short arm of a B (4-5) chromosome was observed in two children (a male, 23 months old, and a female, 4 months old).

Clinical pictures and chromosomal abnormalities were found to be consistent with the findings in the « cri du chat » syndrome.