The dramatic COVID 19 outbreak in Italy is responsible of a huge drop of urological surgical activity: a multicenter observational study

Objective

To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID‐19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID‐19.

Methods

A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo‐Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week‐by‐week, from the beginning of the emergency to the following month.

Results

The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID‐19 cases, experienced a 94% reduction. The decrease in oncological and non‐oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions.

Conclusion

Italy, a country with a high fatality rate from COVID‐19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID‐19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre‐planning in other countries not so drastically affected by the disease to date.

[Laparoscopic removal of voluminous right seminal vesicle neoplasm]

INTRODUCTION

We present the case of a male adnexal tumor of probable Wolffian origin occurred to the right seminal vesicle of a 47-year-old man.

MATERIALS AND METHODS

The patient presented with a 2-month history of hematospermia. The diagnosis was achieved by transrectal ultrasound, CT of the abdomen and pelvis, and biopsy of both prostate and seminal vesicle. The patient was counseled for laparoscopic excision of the right seminal vesicle.

RESULTS

The right seminal vesicle, along with the tumor and the right vas deferens, were excised and clear margins were ensured by frozen section. Total operative time was 180 with 200 mL blood loss. The patient's recovery was uncomplicated and he was discharged on the fourth post-operative day. The histologic examination demonstrated a male adnexal tumor of probable Wolffian origin, which is a rare low-grade malignant neoplasm that has been previously described in the broad ligament, ovaries and retroperitoneum of females. The patient is free of relapse at a 20-month follow-up.

CONCLUSIONS

This is the second report of this entity in a male. The laparoscopic approach for the excision of seminal vesicle neoplasms is a good treatment for its obvious benefits of minimal blood loss, short hospital stay and quick return to normal activity. The magnifications of the anatomical details of the pelvic floor help the surgeon in the dissection of the seminal vesicle from the other structures.

Oncological and Functional Results of Laparoscopic Radical Prostatectomy after 100 Procedures: Our Experience

Laparoscopic radical prostatectomy plays an emerging role in the surgical management of prostatic tumors. We present our experience of the first 100 cases of extraperitoneal laparoscopic radical prostatectomy. Our results about continence, erectile function and surgical margins are reported.

Materials and Methods

Between January 2005 and December 2007, 100 laparoscopic radical prostatectomies were performed by one surgeon. We retrospectively reviewed margins status, operative time, blood transfusion rates, time of catheterization, length of hospital stay, continence and potency rates.

Results

The operative time decreased during the learning curve. The mean duration of surgery was 240 minutes (in the first 25 procedures the median time was 320 minutes, while in the last 25 cases the mean duration was 200 minutes). Five conversions to open surgery were required owing to failure to progress. The overall rate of positive surgical margins was 15% in pT2 and 35% in pT3a tumors. We had 3 minor complications (two anastomotic leakage and one hemorrhage from the anastomosis) and 2 major complications (recto-urethral fistula). The mean intraoperative blood loss was 450 ml (range 200–1500). With regard to transfusion, 25 patients (25%) received their autologous units, while 2% of the patients required homologous units. The mean duration of catheterization was 7.8 days. The continence rate at 12 months was 85%; the potency rate was 55% at 12 months.

Conclusions

The results of the present study show that by using a rational approach to training, a general urologist with low experience in laparoscopy is able to safely perform laparoscopic radical prostatectomy, and with oncological and functional results comparable to those of other published series.

Transperitoneal Laparoscopic Radical Nephrectomy for a 12 cm Renal Mass

Laparoscopic radical nephrectomy is now considered a standard of care for patients with T1 renal carcinoma not suitable for nephron-sparing surgery. In the hands of experienced laparoscopic urological surgeons also T2 renal cell carcinoma can be approached through the laparoscopic technique. We present the video of a radical laparoscopic nephrectomy in a patient with a 12cm renal mass of the right kidney. We chose the transperitoneal approach; the operative time was 240 minutes. There were neither intra- nor post-operative complications. The patient was discharged at day 4 postoperatively.

Anterior Urethral Therapy

Surgical treatment of anterior urethral stenosis encompasses a large number of techniques. In literature there are few prospective studies that could compare the efficacy of different techniques. Most of these studies are retrospective and not multicentric. We present a review of the literature on the treatment of penile and bulbar strictures, focusing the attention on different kinds and numbers of complication, and showing short- and long-term results of each technique.

Dorsal free graft urethroplasty according to Barbagli. Minimum follow-up of 2 years

Series of free graft methroplasties for structure of the urethra according to Barbagli. Fifteen men underwent dorsal free graft methroplasty for structures situated in the penile urethra in 6 cases, in the bulbous urethra in 7 and in the urethra geno bulbous in 2. The length of the structures ranged from 1.5 to 13 cm. In all the patients but one uroflow was satisfactory at a mean follow-up of 40 months. In one patient a reument structure occurred 8 months after treatment and was successfully treated with cold urethrotomy. In conclusion, dorsal free graft urethroplasty is a safe and fairly simple procedure in long bulbous stenosis and penile multi stenosis.

Interstitial cystitis

Interstitial cystitis (IC) is still considered a rare disease, but in the future its incidence will probably be revised if tendency is that of considering interstitial cystitis on the basis of clinical rather than endoscopic-histological criteria. According to some urologists, cystodistension and vesical biopsy, even if not pathognomonic, are still effective up till now, at least for their prognostic-therapeutic value as well. If on one hand in the diagnosis of this condition symptoms tend to be of more and more value unlike instrumental investigations, on the other hand little has changed in therapy.

Transitional Cell Carcinoma of the Posterior Urethra in Men: Our Experience

We present the experience of the Division of Urology of Mantova Hospital about the primitive carcinoma of the posterior male urethra. This kind of tumor is very rare and there are't great experiences that permit to define a standardize therapy.

Material and Methods.

Three cases of primary posterior urethral carcinoma who had been treated at our institution between 1999 and 2001 were retrospectively analyzed. The location of the tumor was in 2 cases in the prostatic urethra and in 1 case in the membranosus urethra. The treatment was cistoprostatectomy in 1 case, cistoprostcatectomy associated with penectomy in the case of carcinoma of the membranosus urethra and a prostatectomy in one case of the carcinoma of the prostatic urethra. In 2 cases an adiuvant chemotherapy with cispaltinum was performed while in the third patient a chemiotherapy with gemcitabina was performed at the presentation of a local relapse of tumor.

Results.

In the case of carcinoma of the prostatic urethra treated with cistoprostatectomy and uretrhectomy and adiuvant chemotherapy there was a good local and distand controll of the cancer with a follow up of 24 months. The patients with carcinoma of the membranosus urethra treated with cistoprostcatectomy associated with penectomy and adiuvant chemiotherapy had a local relapse at 24 months and was treated with radiotherapy. The patient treated with only prostatectomy presented a local relapse at 2 months and distant metastasis at 15 months. After 2 years this patient is still alive but in clinical progression.

Conclusions.

The most adequate treatment in the cases of posterior urethral cancer seems the major surgical treatment with urethrectomy associated with radical cistectomy. In advanced stages chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial cell malignancies seems to give good results. The follow-up of these patients has to be very close.

Pubo-vaginal sling

The Authors discuss their experience in the use of pubo-vaginal sling in the treatment of female urinary stress incontinence. In the last 5 years (1997-2002) 35 patients with type 3 incontinence underwent pubo-vaginal sling with rectus fascia or porcine skin. Healing was obtained in 74.2%, de novo urgency in 5.7%, obstruction in 8.5% and persisting incontinence in 11.4% of cases. The developments of the technique have recently turned pubo-vaginal sling into a minimally invasive procedure with low morbidity. Its indications have therefore been extended to the point that it is now considered by many authors as the treatment of choice in any type of incontinence, whether associated with genital prolapse or not.

Five Year Results after Radical Prostatectomy in Patients with pT3a Patological Stage and Positive Surgical Margins

Five year results in men with pT3a disease and positive surgical margins after radical retropubic prostatectomy were evaluated.

Materials and Methods

Between 1/90 and 12/98, 250 men underwent radical retropubic prostatectomy for prostate cancer. In 63 cases (25%) we found positive surgical margin. In these group 32 patients presented pathological stage T3a N0 with a Gleason score between 5 and 8. In 21 patients no adiuvant therapy was made while 11 patients underwent an adiuvant therapy (in 2 patients ormonal therapy, in 9 radiotherapy).

Results

The actuarial 5 years post prostatectomy biochemical, local and distant recurrence rates were 9%, 3% e 3 % respectively. For 21 men who didn't receive adiuvant therapy, 17 were biochemical recurrence free, in 3 cases a biochemical recurrence occurred, 1man underwent a radiotherapy of salvatage for a local recurrence. For 9 patients who received adiuvant radiation therapy, 8 are biochemical free while 1 presents metastatic desease at 5 years of follow-up. The 2 patients who received adiuvant hormonal therapy are biochemical recurrence free at 5 years.

Conclusions

The role of positive surgical margins on local recurrence of desease is still under debate. In our experience isolated local recurrence is rare during long term follow up of men with pT3a No stage and positive surgical margins at radica prostatectomy. The adiuvant radiotherapy seems to give a good local desease control at 5 years of follow-up.

[Complications of urinary diversion after radiotherapy]

Primary radiation therapy may be recommended for patients with invasive bladder cancer, gynecological or prostatic cancer. When complications occur or in case of malignant recurrence, urinary diversion may be the best chance to restore an acceptable quality of life. The complication rate after this surgery is doubled. We report our experience in 32 patients submitted to urinary diversion after radiotherapy from 1985 to 2000: 2 enteric fistulas; 2 urinary fistulas; 5 stenosis of uretero-intestinal anastomosis were our complications. Radical cystectomy (24 cases) or anterior pelvic exenteration (8 females) preceded urinary diversion. Preoperative high-dose radiotherapy contributes to increased postoperative morbidity rates, particularly entero-enteric fistulas, uro-intestinal fistulas and stenosis of the uretero-intestinal anastomosis. In our experience, in most of the major urinary or enteric complications non surgical management was inefficient and surgical management was necessary.

[Pathology of the gynecologic ureter: our experience]

Endometriosis, surgery and radiotherapy are the main causes of ureteral injuries in gynaecologic pathology.

MATERIALS AND METHODS

In this paper we present our experience about ureteral injuries. We treated 31 patients; 6 cases of endometriosis, 13 cases of pelvic radiotherapy for gynecologic tumors, 12 cases of ureteral injuries after gynecologic surgery. The treatments were different depending on the cause of the lesion and on the site of the lesion. In 3 cases we performed an ureteral-bladder implant with bladder psoas hitch, in 2 cases an end to end anastomosis was made. In 2 cases we made an ureteric substitution with Boari bladder flap. In 8 cases the ureteral stenting with DJ or a percutaneous nephrostomy was the solution.

RESULTS AND CONCLUSIONS

In our experience good results can be obtained with ureteral implant and bladder psoas hitch. The end to end ureteral anastomosis had disappointing results in our hands. In case of ureteral fistula it would be better repair it as soon as possible. If the ureteral lesion is recognised during surgery and the loss of substance is not complete, the suture on stent can be performed.

[Interstitial cystitis: epidemiology]

The epidemiological assessment of intestitial cystitis (IC) is not definitive as no diagnostic criteria, such as endoscopy or biochemical and anatomopathological examination, exist. The diagnosis is solely based on symptoms like urgency, frequency and pelvic pain. The first studies on the population date back from 20 years ago and show a percentage of 10 cases every 100 thousand inhabitants. There is weak link between genetic factors, immunological diseases, previous cystitis or eating habits and intestitial cystitis. Epidemiological studies have highlight the frequency of this disease, and stressed the importance of stricted behavioural rules for the first stages of intestitial cystitis.

[Interstitial cystitis: surgical treatment]

Surgical therapy of interstitial cystitis must never be considered a first option but must be reserved for cases, less than 10%, in which conservative therapy has proven ineffectual. Surgical therapy includes a variety that started at the turn of the century. Neurosurgical denervation and perivesical denervation like cysto-cystoplasty and cystolysis, manipulate the innervation to reduce the bladder's hypersensitivity. This surgical approach may be considered in patients in whom bladder capacity is normal. The results are uncertain and the complications like neurogenic bladder relevant. Enterocystoplasty is much more widespread because interstitial cystitis is a benign disease that rarely required radical surgery. Augmentation cystoplasty and substitution cystoplasty are two variants but only the later has a rationale as it involves the resection of the detrusor which is the source of the pain. Detubularization drastically reduced urinary incontinence. The resection of the detrusor can be supratrigonal, subtrigonal or at the proximal urethra like in the orthotopic neobladder. If urinary diversion is chosen, the bladder must be removed. Before recommending surgical therapy each patient should undergo tests for the localization of the pain; moreover psychological and gynaecological evaluations should be made. If the bladder capacity exceeds 400 cc surgical operation is not advisable. If, on the other hand, the bladder capacity is lower than 400 cc substitution cystoplasty is first choice. If the patient suffers from trigonal cystitis or urethral hypersensitivity, urinary diversion is a better therapy. According to the questionnaires send to the Urologic Departments in Lombardy in 1998, the most widespread type of operation seems to be supratrigonal cystectomy + enterocystoplasty and augmentation cystoplasty. Subtrigonal cystectomy or urinary diversion are only occasionally chosen; continent pouch is the least frequent therapy at all.

Shock Wave Treatment of Peyronie'S Disease: Our Experience

From September 1997 to April 1998, 40 patients with induratio penis plastica were treated with extracorporeal shock waves (ESWT). This work compares our results with those of the main Italian centres that first used this method. The aim of this study is to assess the efficiency of the treatment in the period before the main guidelines were laid down: guidelines which from now on should standardise indications and methods of application whilst optimising results.

Uretero-lithotripsy with the Swiss Lithoclast

Technological developments in ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) have changed the treatment of ureteral stones over the last decade. “In situ” ESWL is now the treatment of choice in the management of ureteral calculi. Ureterolithotripsy should be preferred in certain cases, however, especially when the stone cannot be perfectly sighted or when the urinary tract needs to be drained due to obstruction and/or sepsis, with a saving of one ESWL session in 50% of patients. Current options that can be applied with lithotripsy are: electrohydraulic, laser, ultrasound and ballistic tripsy. The authors describe their experience with the Lithoclast in 82 patients. This technique has proved to be simple, safe, effective and particularly economic.

Uretroplastica a lembo libero dorsale

The Authors report their experience in the new urethroplasty technique by Barbagli for penile and bulbar urethral strictures. This procedure involves a free skin graft sutured to the corpora cavernosa. With this dorsal approach mechanical weakening is virtually impossible, so pseudo-diverticulum or urethrocele cannot develop. We adopted this technique in 5 patients during the last 12 months. The strictures of the urethra were 2.5 to 8 cm long. The follow-up, even thought short, show that this technique is safe and quite simple.

Amiloidosi polidistrettuale. Implicazioni urologiche

Amyloidosis covers a group of morbid processes which have the common characteristic of amyloid being deposited in an extracellular site of one or more organs. The mechanisms causing amyloidogenesis are still unknown. Involvement of the urinary apparatus is more frequent with primary amyloidosis and myeloma (AL form) as well as inflammatory or neoplastic diseases (AA form). The disease in the kidney is characterised by proteinuria progressing to the nephrotic syndrome and renal failure, while frank hematuria is typical of the disease in the bladder. In our case emergency cystectomy was performed because of severe anemia consequent to hematuria. Prodromal symptoms were asthenia, loss of weight, purpura and subsequent to involvement of the urinary tract, also gastroenteric, cardiac, neurovegetative, articular and thyroid disorders typical of multi-district involvement. Diagnosis is confirmed only after the histological examination and average survival rate is 20 months. There is no fully effective therapy.

[Replacement neobladders in men and women: our experience]

We present our clinical and metabolic follow-up data of 74 patients submitted to total bladder substitution using an ileal orthotopic neobladder in one group of 64 patients and a continent stomal pouch in another group of 10 patients. In the first group the mean follow-up was 41.5 months. The daytime continence was early achieved in 89% (57/64) and was maintained with time; at 12 month follow-up nocturnal continence was reached in 71% (45/64). Post voiding residual was significant only in 4 patients (2 men and 2 women). No clinical signs of pyelonephritis nor renal scars at IVP was evidenced in all but 7 patients in which a silent uretero-ileal stenosis developed. No severe metabolic acidosis or B 12 deficiency occurred. In the second group (Continent Pouch) the long term 3-Year follow-up shows a complete continence in all patients with an average capacity of 600 cc. No late complications occurred in all patients but one in which self intermittent catheterization was uncomfortable and now he prefer permanent catheter and in another patient with a stone in the Pouch treated with Lithoclast. In conclusion, total bladder substitution after radical cystectomy is now represented by orthotopic neobladder or continent Pouch in men and women. Early and late complication rate is relatively low and continence generally good.

[T1G3 bladder tumors: 5 years later]

We have evaluated 79 patients affected by bladder cancer T1G3: 31 underwent just endoscopy, 11 radiotherapy, 10 cystectomy and 27 topical chemotherapy. At five years 44 patients were alive and disease free, 7 were alive but recurrent in TA, 3 were alive but in metastatic progression, 17 were died because of the tumor, 3 died because of the therapy, and 5 died disease free. The authors believe that this patients could be treated with BCG as first treatment choice performing cystectomy when relapse or progression occuring.

[Turbo TURP]

Transurethral resection of the prostate (TURP) is just one of the numerous options available in the modern treatment of benign prostatic hyperplasia (BPH), but it's still now the "gold standard". Absorption of irrigating fluid is the greatest complication and results in clinical manifestations in 2% of the TURPs performed. There is a statistically significant relationship between gland size and the total volume of irrigant absorbed. To reduce this absorption Reuter introduced suprapubic trocar drainage to obtain the same results from both the small and the large prostates. Operating time, in fact, is reduced because, also at the same time, this large tube drains both irrigation fluid and prostatic chips.

Ectopic “blind ureterocele”: Report of 2 cases

— Ureterocele without corresponding renal tissue has been called blind ureterocele. We observed this rare malformation in two cases: a 17-year-old youth with the ureteral orifice located at the seminal vesicle and a 25-year-old woman with the orifice at the bladder neck. In both cases the proximal ureter ended in the lumbar fossa without renal parenchyma. The etiology of this ureterocele is unclear. Functioning renal tissue is supposed to be necessary for the development of a ureterocele: in blind ureterocele the renal parenchyma could subsequently disappear.

Quality of micturition after prostatectomy for pT3 carcinoma

— The purpose of radical prostatectomy for neoplasia is to cure the patient and maintain a good micturition. The first aim is achieved only in patients with localized prostatic cancer. With cancer not confined to an organ, we cannot be sure of radicality. These patients run the risk of local recurrence and worsening of micturition. The quality of micturition is determined by both surgical procedure (sphintecal weakness, stenosis of the urethro-vesical anastomosis) and local staging of the neoplasia (whether local recurrence is present or not). We studied 56 pT3 patients with uroflowmetry and symptom score. The flowmetry was always good even when local relapse occurred, but worsened when stenosis started. Urgency was the most frequent symptom in patients with local relapse.

[Our experience with impotence following radical pelvic surgery]

The etiology of impotence after radical prostatectomy and radical cystoprostatectomy is unclear, although a variety of potential factors have been cited: neurogenic, psychogenic and vascular. Injury to the pelvic nerve plexus and the branches that innervate the corpora cavernosa (cavernous nerves), seems to be the most important iatrogenic factor. The Authors selected 14 patients candidate to radical prostatectomy or radical cystoprostatectomy and studied their potency pre and post operatively by anamnesis and/or Rigiscan test. The sacral-evoked potential was determined in all these patients in order to detect a neurological etiologies. The average latency of the bulbo cavernous reflex was similar in the patients that lost their potency after surgery and in the patients that didn't lose their potency after surgery. The sacral-evoked response seems not to be a diagnostic test in the study of the impotence after pelvic radical surgery.

Impalamento e lesioni retto-vescicali

Impalement with associated bladder injuries was observed in 4 patients. The treatment should be individualised but careful debridement of all necrotic tissue, urinary and fecal diversion, separation of the injured sites with wall-vascularised tissue such as peritoneum or omentum should reduce the high incidence of fistulae or bladder stones. Endoscopic or surgical exploration of the bladder is mandatory because foreign bodies risk creating calculi, like in our 2 cases.

Lo studio dell'impotenza nel paziente diabetico

In our Andrologic Unit a diagnostic trial for studying impotence in diabetic men has been assessed in co-operation with the Metabolic Diseases Center and Neurologic Division of this Hospital. By metabolic, hormonal, vascular and peripherical neurological examinations it has been possible to find in a short time diseases where impotence was only the first sign.

[Transrectal echography in the diagnosis of cervico-urethral obstruction in the young]

The authors present a case of severe cervico-urethral obstruction by Von Brunn cysts. These cysts are often found even in macroscopically healthy bladders, but only rarely reach such a size as to be revealed by ultrasound. They can be asymptomatic or cause obstruction if large. They are no longer considered preneoplastic lesions and are therefore treated according to symptoms. When these cysts cause dysuria they are removed, preferably by transurethral resection, as it is the only method (unlike needle aspiration) which prevents recurrence.

Rare Renal Ectopia: Description of 2 Cases

Two cases of kidney ectopia are reported; a rare thoracic kidney and a very unusual supernumerary ectopic pelvic kidney. The patient with toracic kidney was casually referred to us, the second instead had a low urinary tract syndrome: burning and mild urgency. The diagnostic management and clinical characteristics of these rare pathologies are reported.

Urinary Tuberculosis: From Demolition to Reconstruction

Tuberculosis is increasing in Italy and even today is still a progressive fatal illness if not treated quickly. Drug therapy still plays an important role, while endoscopy and surgery offer further therapeutic possibilities compared to the past, with excellent results regarding the most feared complication - cicatricial stenosis. Simple ureteral endoscopic dilation with catheters has given way to the insertion of modern well-tolerated in-dwelling stents that can be used even with upper calyceal stenoses. Reconstructive bladder surgery, making new orthotopic-bladders, is a valid method for treating retracted bladders. The authors report their experience in treating TBC complications in 45 patients and in particular one paradigmatic case of urinary tuberculosis with serious stenosis involving the complete urinary system between the pelvis and the distal urethra. Urethroplasty and new orthotopic ileal bladder allowed the patient, who previously had an external deviation, to micturate naturally again.

Topical Epirubicin as Treatment of in Situ Bladder Carcinoma

15 patients with primitive carcinoma in situ of the bladder were administered 50 mg/week of Epirubicin; 14 responded to this control therapy with negative urinary cytology and biopsies within an average of 25.6 months. After an average follow up of 47.7 months, 8 out of the 15 patients are still in a state of complete remission, 1 has a recurrent grade 3 carcinoma, 5 are in progression (3 T1 and 2 T2) and 1 has a grade 2 Ta recurrence. 3 patients died from the disease.

Pelvic floor rehabilitation for the treatment of female urinary incontinence. Our experience

The authors report their experience in the treatment of female urinary incontinence with pelvic floor rehabilitation. Electrostimulation and biofeedback technique is applied. Results are satisfactory both in stress incontinence and urge incontinence. In the latter case urine lass in non-elderly patients, must be reduced and out-patients’ rehabilitation must absolutely be carried out. Anticholinergic drugs have often been administered in urge incontinence.

Supernumerary kidney

The authors report the case of a supernumerary kidney with pelvic ectopy in a 22-year-old man complaining of dysuria with leukocyturia and sterile urine. Urography, ultrasonography, C.T. and endoscopic probe revealed a small, supernumerary kidney in the left side of the pelvis between the bladder and the seminal vesicles with short ureter ending in ureterocele. Symptoms cleared up thanks to the quick pharmacological treatment so that no further ureterocele endoscopic probe was considered necessary, to avoid submitting the patient to the risk of secondary vesicles ureteral reflux and subsequent sepsis requiring difficult nephroureterectomy.

Severe obstruction by Von Brunn cysts

The authors present a case of severe cervico-urethral obstruction by Von Brunn cysts. These cysts are often found even in macroscopically healthy bladders, but only rarely reach such a size as to be revealed by ultrasound. They can be asymptomatic or cause obstruction if large. They are no longer considered preneoplastic lesions and are therefore treated according to symptoms. When these cysts cause dysuria they are removed, preferably by transurethral resection, as it is the only method (unlike needle aspiration) which prevents recurrence.

The study of erectile deficit by Rigiscan

The most widely used tests for a correct diagnosis of organic and psychogenic impotence are nocturnal erection monitoring, penile Doppler and intracavernous injection. 45 patients affected by impotence underwent NPT test while penile Doppler was performed in 32 cases; another 9 patients were given a PGE1 injection followed by real-time monitoring. A Rigiscan monitoring unit for penile rigidity and tumescence measurement was used to perform NPT and real-time FIC. NPT showed organic alteration in 15 cases, psychogenic deficit in 23 and dubious results in 9, (NPT was repeated in 2 cases). Doppler flowmetry was negative in 24 cases while it detected disease in 8. 13 of these 32 patients showed organic disease on NPT, 11 had negative results and 8 cases were considered dubious. Rigiscan nocturnal erection test seems to be the most reliable test for a correct assessment of impotence especially if it is used in combination with intracavernous injection.

[Suprapubic bladder ultrasonography and urinary cytology: indications and limits in the follow-up of superficial bladder tumors]

139 patients underwent urinary cytology and bladder sonography in follow-up of superficial bladder cancer (Ta G1-3) alternatively or at the same time of cystoscopy. Medium follow-up was 27.2 mos. In 7.91% there was progression to T1 o T2 but no case escaped this protocol. In 9% urinary cytology and bladder sonography were both falsely negative: tumors were smaller than 0.5 cm and low grade. In 76 patients with Tar bladder cystoscopy rate was 1/5.2 mos. before this study and 1/7.2 mos. after this study. In our opinion this protocol reveals the recurrence of superficial bladder tumor, reduce cystoscopy rate with no risk of ignored progression.

Ovarian remnant syndrome: a case report

A case is reported of ureteral obstruction due to retained corpus luteum. The patient had previously undergone a hysterectomy and salpingo-ovariectomy with incomplete removal of ovarian tissue on both sides. The ureteral obstruction was treated by the excision of the mass and the reimplantation of the obstructed ureter into the bladder hitched to psoas muscle.

[Cryptorchism and fertility. Our experience]

The relationship between cryptorchidism and fertility has been suggested in a lot of ways but hasn't been clearly demonstrated. In our Institute from 1981 until 1987, 352 orchidopexies had been performed. Out of these, 31 patients were studied with respect to the current age, the age at the surgery, the absence of varicocele and the possible iatrogenic damages. The rate of dispermia among the subjects studied, was 43% whereas 57% had normospermia. 3 out of 4 patients operated for bilateral undescended testis were azoospermic. The volume of unaffected testis is directly related to the health of the seminal status.