Once-a-day Tadalafil administration improves the spermogram parameters in fertile patients

OBJECTIVES

We explored the safety of Tadalafil once-daily treatment for 12 week and its effects on semen quality in a clinical subpopulation of men with psychogenic erectile dysfunction (ED).

PATIENTS AND METHODS

Twenty-seven men, between 19 and 35 years, unaware of their fertility status, suffering from psychogenic ED were enrolled. The examination of the seminal fluid was performed twice before administration of Tadalafil and twice after three months of continuous daily administration of Tadalafil 5 mg. The volume of the seminal fluid, the concentration of sperm, the concentration of sperm with type "a+b" motility, the concentration of sperm with type "a" motility, the concentration of normal sperm were taken into consideration. The results before treatment with Tadalafil (T0) and after 3 months of treatment (T3m) were compared.

RESULTS

The administration of once-daily Tadalafil 5mg, brings to an average increase of the total number of sperm cells, both total and fast motility (type a) and the percentage of nemasperms, and to an average increase of semen volume of only 0.41 ml. These quantitative and qualitative improvements of the seminal fluid resulted statistically significant as regard motility, nemasperm percentage and seminal fluid volume. No unespected safety findings were observed.

CONCLUSIONS

Tadalafil administration improves the quality of sperm cells and seminal fluid: in particular motility, percentage of nemasperms and volume of seminal fluid. We emphasize the safety of the once-daily treatment with tadalafil 5mg and the positive effects on spermatogenesis.

Spontaneous rupture of urinary bladder: a case report and review

Spontaneous rupture of the bladder is a rare event. The clinical presentation shows the signs and symptoms of peritonitis, but the diagnosis is made at the operating table. This event is burdened with a high mortality rate. We present a case report of a 73-year-old man who came to our observation. He was a chronic carrier of urinary catheter, at least 7 times removed traumatically by himself. At the time of admission he showed drastic reduction in urine output, absence of hydronephrosis, normal functioning of the catheter, a tense and widely meteoric abdomen, the presence of air-fluid levels, normal kidneys, absence of free fluid in the abdomen. The CT showed a fluid collection of about 7 cm diameter between the bladder and rectum. The explorative laparotomy found a small fissuration of the posterior wall of the bladder. For his severe conditions, the patient died a few hours after surgery, in intensive care unit. Although it is a rare event, since 1980, 177 cases of spontaneous rupture of the bladder are reported in the literature. Their causes may be essentially divided into two groups: for increase of intravesical pressure; or for weakening of the bladder wall. In most cases, the spontaneous rupture of the bladder takes place in presence of a urothelial neoplasm or after radiation therapy of the pelvic organs. The etiology of spontaneous rupture of the bladder in our case does not relate to a bladder tumor or radiotherapy. It may have been caused by repeated episodes of acute retention of urine with extreme bladder distension up to 3 liters. It is not easy to think of a bladder perforation in patients presenting signs of peritonitis without a history of bladder cancer or pelvic radiotherapy. A CT with intravesical contrast medium could help the diagnostic orientation.

Comparison of ESWL outcome between Wolf Piezolith 3000 vs. storz Modulith Slk. it is the man who makes efficient the machine

AIM OF THE STUDY

The choice of an extracorporeal lithotripter for extracorporeal shock wave lithotripsy (ESWL) of urinary stones must be done with efficacy criteria. It is easy to demonstrate the advantages of the third-generation lithotripters compared to previous generations of lithotripters. This study has the purpose of evaluate whether it is possible to establish differences in effectiveness between two third generation lithotripters.

METHODS AND RESULTS

We report about the last 100 ESWL treatments carried out with the Wolf Piezolith 3000 and the last 100 with the Storz Modulith SLK, performed by the same single operator. Stones were stratified by site and size. Comparison was made considering the number of shock waves per session and the number of sessions and the outcomes. The results showed no statistically significant differences. In fact, the cumulative stone-free rate was 93% for the Wolf Piezolith and 91% for the Storz Modulith.

CONCLUSIONS

The technical differences between lithotripters concern the energy delivered, the shape of the acoustic focus, the depth of focus, the coupling surface, the mobility of the head, the alignment mode and the simultaneous use of ultrasonography and radiological pointing. These differences are never obtained from published series. Furthermore data of patients and stones that have not been treated for the difficulty of stone targeting due to the depth of acoustic focus (high BMI), the limited inclination of the head or to the patient intolerance to shock waves are not usually reported. The results obtained by the same operator are comparable even when are obtained with different machines of the same generation. The real differences could arise if we would take into account also the patients which were excluded from evaluation because, for the same generation of lithotripters, the results depend on the operator, while the eligibility to treatment of the patient depends on the characteristics of the machine.

TURP and PVP treatments are really similar? From subjective feeling to objective data. Pilot study (proof of concept) prospective randomized trial

Transurethral resection of the prostate (TURP) is the gold standard of surgical treatment of the BPH. Alternative surgical techniques have been developed for patients with blood coagulation disorders secondary to anticoagulants or antiplatelet intake. The photoselective vaporization of the prostate (PVP) by Green Laser is a technique used with the aim of obtaining tissue ablation with instantaneous hemostasis. In our experience we sensed the feeling of some differences between the two technologies. For each patient, we calculated the difference (delta) between Qmax, Qmed, PMR to 6 months after surgery compared with preoperative measurements (deltaQmax, deltaQmed, deltaPMR). In the comparison between PVP and TURP the differences between the results, in terms of deltaQmax (11.04 vs. 8.9 ml/sec), deltaQmed (5.87 vs. 3.64 ml/sec), deltaPMR, are not statistically significant, therefore it is clear that if we consider the average of the results, significant differences do not come out between the two techniques. Instead, the real differences emerge from consideration of standard deviations: the higher standard deviations of Qmax and Qmed of PVP compared to TURP (8.29 vs 5.01; 5,51 vs 1.64) indicate that the final result of an intervention being performed by TURP is nearest to the expected preoperatively result; on the contrary the final result of an operation being performed by PVP shows a significantly higher variability. As regards for our clinical decision it follows that the proposal of a surgical procedure which shows the "risk" of a higher variability of the final result is justified only in cases of high cardiovascular or blood coagulation "risk".

Torsion of a neoplastic intrascrotal testis: when the torsion reveals the mass. A case report and review

Cases of torsion of the spermatic cord are rare in men over 30-years-old. Testicular tumors manifest themselves rarely with symptoms of acute scrotum. We report the case of a 38-years-old patient who presented for a suspected left testis torsion. On examination, the testicle was markedly increased in size and painful. The manual derotation made pain dramatically disappear. He came to our attention after about a month asking for an orchidopexy. During the surgery a biopsy was performed. The diagnosis was a Yolk Sac Tumor. A radical inguinal orchiectomy was performed with left hemiscrotal excision, "in block". He performed four cycles of chemotherapy and with no recurrence after 12 months of follow-up. In literature only seven cases of torsion of an intrascrotal testicle with cancer are reported. Our case is the eighth one.

Hydrocele with surprise. Case report and review of literature

INTRODUCTION

Hydrocele is a fluid collection between tunica vaginalis and testis. Approximately 10% of testicular cancers occurs with a reactive hydrocele.

CASE REPORT

A 64 year old male presented with a 30 year history of left hydrocele, progressively increasing. Physical examination demonstrated a left large hydrocele, transilluminable, not under pressure. Ultrasonography showed a "corpusculated hydrocele with vaginal hypertrophy jutting out near the head of the epididymis, perhaps caused by an inflammatory reaction [...]" As the patient showed only a minimal discomfort due to the groin swelling, without pain, surgical excision was planned without priority (Class C < 180 days).

RESULTS

The surgical exploration showed a paratesticular papillary neoplasm of 3 cm. Intraoperative pathologic examination of a frozen sample demonstrated a "borderline papillary cystadenoma". The Left orchifunicolectomy was performed. The definitive histological examination showed a "left paratesticular Papillary Serous Tumor of Low Malignant Potential (PSTLMP) with morfoimmunoistochemical features of Mullerian origin of neoplasm". Computed tomography (CT) was negative for lymph nodes and metastasis. In agreement with the oncologist we decide for atchful waiting.

DISCUSSION

Despite of rich personal experience of resections and eversions of the vaginal tunic, an urologist rarely observes a case of paratesticular cancer. A PubMed search found 28 citations between 1985 and 2010 with 42 reported cases of paratesticolar neoplasm, including 27 with malignancy features. Rhabdomyosarcoma is the most common, followed by mesothelioma, adenocarcinoma and neuroblastoma. This case report consists of a "borderline" neoplasm for which in the literature, after orchiectomy, it is reported no case of recurrence or metastasis (with a follow up of up to 18 years).

CONCLUSION

The banality of the disease never must underestimate the possibility of an undetected cancer.

"And if a one night a renal colic..." the strange case of renal vein thrombosis without renal cancer

INTRODUCTION

It is common experience to all urologists to manage many patients admitted at night from the casualty ward with a diagnosis of "therapy-resistant renal colic". However not all the patients with flank pain really suffer for renal colic, although painful somatic irradiation refers to the same areas.

CASE REPORT

A seventy years old male patient was admitted from the casualty ward for left renal colic. Laboratory tests showed normal creatinine, mild reduction of albuminemia, elevated triglycerides and cholesterol at the upper limit of normal. The pain had risen sharply a few hours before. For some years the patient suffered nocturia, but he never made an urologic consultation. Ultrasonography performed in the casualty ward demonstrated normal findings with no hydronephrosis but the presence of left perirenal extravasation with "casting-like" aspect and extending to the pelvis. Contrast-enhanced computed tomography (CT) revealed the presence of left renal vein thrombosis and acute segmental pulmonary embolism. The left kidney, apart from increased volume and reduced parenchymal impregnation, showed no neoplastic nodule. The case presented as unusual according to the opinion of consulted nephrologists, vascular surgeons and urologists (also from others hospitals and universities). After informed consent of the patient (stressing seriousness and singularity of his condition), we decided to treat him as a deep vein thrombosis. We administered an heparin bolus (80UI/kg), followed by the infusion of heparin (18UI/kg/h) using a peristaltic pump for 14 days.

RESULTS

CT performed after 14 days of treatment showed the full resolution of renal vein thrombus and of pulmonary embolism. Thereafter a nephrotic syndrome was diagnosed and the patient was took in care by the nephrologist. Nephrotic syndrome preceded the hospital admission of the patient and was the etiological cause of renal vein thrombosis.

DISCUSSION

The well known causes of acute flank pain reported in textbooks include renal and perirenal inflammatory processes, renal cell or transitional cell cancers of the kidney or of the urinary tract, obstruction of the urinary tract by stones or stenosis, hydronephrosis of different etiology whereas vascular causes are not often mentioned.

CONCLUSIONS

After the diagnosis of left renal vein thrombosis, the more probable associated urological is a renal cell carcinoma. Excluding renal cancer other possible causes of thrombosis are medical conditions such as amyloidosis, multiple myeloma, nephrotic syndrome, thrombophlebitis.

[Systematic biopsy with multiple samples per lobe in the diagnosis of prostatic carcinoma]

A new fashion of prostate transperineal biopsy (seven cores from each lobe) is described, in order to evaluate a potential increase of prostate cancer detection rate. From June 1996 to PSA. April 1997, 247 patients underwent transperineal biopsy for an abnormal DRE and/or elevated In addition to apex, base and lateral peripheral samples, two more were obtained from middle-lateral peripheral zone and tow more from transition zone of each lobe of the prostate. In 14 patients (13.1%) carcinoma was detected in the additional samples only. This new biopsy fashion seems to be safe and more accurate than sextant biopsy for a significant percentage of cancer that otherwise would have been missed.

[Role of expectant therapy in prostatic carcinoma of low grade and staging]

Low stage and grade prostate cancer can be treated by radical prostatectomy, radiotherapy and expectant therapy. Preoperative evaluation with biopsy is in many cases unreliable to pathological stage and grade. In this study we considered 31 patients with prostate cancer, evaluated with directed ultrasound guided biopsy (15) or with sextant biopsy (16). Sextant biopsy showed better results. Grading was confirmed by radical prostatectomy specimen in 62.5%. The role of expectant therapy is then discussed.