Robot-Assisted Extraperitoneal Radical Prostatectomy for Giant Multilocular Prostatic Cystadenoma: A Case Report and Literature Review

A 48-year-old man with a medical history of hypertension and no family history of prostate cancer presented with abdominal distension, lower abdominal pain, and lower urinary symptoms. Physical examination revealed a palpable mass in the lower abdomen, and a digital rectal examination detected a firm mass on the anterior side of the rectum. Laboratory tests showed an elevated PSA level (7.9 ng/mL). Imaging studies indicated a solid mass connected to the prostate's posterior and rectum's anterior walls, along with bladder compression. Transperitoneal biopsy and histological analysis led to a diagnosis of a stromal tumor with uncertain potential malignancy. Considering the absence of apparent malignancy signs and the smooth outer wall of the tumor, the patient underwent, for the first time in the literature, a robot-assisted radical extraperitoneal prostatectomy for complete macroscopic resection. The surgery involved excision of the bulky pelvic mass, preservation of the urethra, and anatomical reconstruction. The postoperative course was uneventful, and we discharged the patient with no complications. The pathological examination documented the diagnosis of multilocular prostatic cystadenoma. Post-surgery follow-up examinations, including PSA levels and imaging scans, showed no signs of tumor recurrence. At the 3-, 6-, and 9-month follow-ups, the patient was asymptomatic and had fully recovered, with no urinary or sexual dysfunction reported.

Electro-mediated drug administration of mitomycin C in preventing non-muscle-invasive bladder cancer recurrence and progression after transurethral resection of the bladder tumour in intermediate- and high-risk patients

Objective

To evaluate the effectiveness of electro-mediated drug administration of mitomycin C (EMDA/MMC) after transurethral resection of the bladder tumour (TURBT) in preventing non-muscle-invasive bladder cancer (NMIBC) recurrence and progression and to explore clinical and demographic factors associated with treatment response.

Patients and methods

Between April 2016 and August 2019, 112 patients diagnosed with intermediate- or high-risk NMIBC underwent a TURBT followed by an EMDA/MMC treatment. The percentage of treatment responders and progression-free survivors at 3 and 6 months were evaluated.

Results

Follow-up data were available for 101 patients (90%) at 3 months and 92 (82%) at 6 months. Response rates to EMDA/MMC treatment were 85% at 3 months and 75% at 6 months, and progression-free rates were 94% and 90%, respectively. No statistically significant differences were seen between intermediate- and high-risk patients. A higher risk of tumour recurrence and progression was associated with previous Bacillus Calmette–Guérin (BCG) failure. According to the Clavien–Dindo classification, only low-grade complications were observed.

Conclusions

EMDA/MMC after TURBT was associated with high response and progression-free rates at 3 and 6 months, with only low-grade adverse events. These results confirm the efficacy and safety of EMDA/MMC as a therapeutic option for both intermediate- and high-risk patients. However, patients with BCG failure responded poorly to EMDA/MMC.

Abbreviations: ACCI: age-adjusted Charlson Comorbidity Index; CHT: chemohyperthermia; CIS: carcinoma in situ; EMDA: electro-mediated drug administration; EORTC: European Organisation for Research and Treatment of Cancer; IQR: interquartile range; (N)MIBC: (non-)muscle-invasive bladder cancer; MMC: mitomycin C; OR, odds ratio; TURBT: transurethral resection of the bladder tumour

Enzalutamide in patients with castration-resistant prostate cancer: retrospective, multicenter, real life study

BACKGROUND

Metastatic castration-resistant prostate cancer (mCRPC) is the final stage of pCa history and represents a clinically relevant phenotype with an elevated burden of mortality. The aim of the present study was to evaluate the efficacy and safety of enzalutamide in a "real-life" setting in mCRPC patients.

METHODS

Data about all mCRPC patients treated with enzalutamide from September 2017 to September 2018 were collected. Demographics, comorbidities, clinical parameters, outcomes, toxicity, overall survival and progression free survival were analyzed.

RESULTS

Overall, 158 patients were enrolled. Mean age was 75.8 (±8.7) years with a baseline median PSA of 16.5 (IQR 7.4-47.8) ng/mL. The median follow-up lasted 7.7 (IQR 4-14.1) months. Of all the 10.1% of patients reported grade 3-4 adverse events. 43.7% of patients experienced a progression. Overall, the 6 and 12 months PFS rates were 69.5% (95% CI: 61.7-78.3%) and the 45.6% (95% CI: 36.5-57.1%); a median baseline PSA>16 ng/mL (HR:2.0, 95% CI: 1.2-3.3, P<0.005), the use of opioid (HR: 3.1, 95% CI: 1.9-5.0, P<0.001), a previous treatment (abiraterone, docetaxel or abiraterone + docetaxel) were significantly associated with higher rates of cancer progression. Conversely, a brief pain questionnaire of 0-1 (HR: 0.4, 95% CI: 0.2-0.7, P<0.001), a 12 weeks 50% PSA reduction (HR: 0.4, 95% CI: 0.2-0.8, P<0.006) and a longer time to mCRPC (HR: 0.4, 95% CI: 0.3-0.7, P<0.002) were related to lower cancer progression rates.

CONCLUSIONS

Our data shows an effective and safe profile of enzalutamide in a "real world" perspective in patients with mcRPC.

Enzalutamide in patients with castration-resistant prostate cancer: retrospective, multicenter, real life study

BACKGROUND

Metastatic castration-resistant prostate cancer (mCRPC) is the final stage of pCa history and represents a clinically relevant phenotype with an elevated burden of mortality. The aim of the present study was to evaluate the efficacy and safety of enzalutamide in a "real-life" setting in mCRPC patients.

METHODS

Data about all mCRPC patients treated with enzalutamide from September 2017 to September 2018 were collected. Demographics, comorbidities, clinical parameters, outcomes, toxicity, overall survival and progression free survival were analyzed.

RESULTS

Overall, 158 patients were enrolled. Mean age was 75.8 (±8.7) years with a baseline median PSA of 16.5 (IQR 7.4-47.8) ng/mL. The median follow-up lasted 7.7 (IQR 4-14.1) months. Of all the 10.1% of patients reported grade 3-4 adverse events. 43.7% of patients experienced a progression. Overall, the 6 and 12 months PFS rates were 69.5% (95% CI: 61.7-78.3%) and the 45.6% (95% CI: 36.5-57.1%); a median baseline PSA>16 ng/mL (HR:2.0, 95% CI: 1.2-3.3, P<0.005), the use of opioid (HR: 3.1, 95% CI: 1.9-5.0, P<0.001), a previous treatment (abiraterone, docetaxel or abiraterone + docetaxel) were significantly associated with higher rates of cancer progression. Conversely, a brief pain questionnaire of 0-1 (HR: 0.4, 95% CI: 0.2-0.7, P<0.001), a 12 weeks 50% PSA reduction (HR: 0.4, 95% CI: 0.2-0.8, P<0.006) and a longer time to mCRPC (HR: 0.4, 95% CI: 0.3-0.7, P<0.002) were related to lower cancer progression rates.

CONCLUSIONS

Our data shows an effective and safe profile of enzalutamide in a "real world" perspective in patients with mcRPC.

The variation of selective uNGAL levels after robot-assisted partial nephrectomy: Early results of a prospective single center study

OBJECTIVES

Acute kidney injury (AKI) secondary to nephron-sparing surgery represents a significant problem in order to preserve renal function. Since serum creatinine alone underestimates the early detection of AKI several biomarker have been investigated. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is considered a good biomarker for AKI.

MATERIALS AND METHODS

We report our experience in 28 patients affected by localized renal cell carcinoma and submitted to robot-assisted partial nephrectomy (RAPN). In each patient selective urinary NGAL levels were dosed before surgery, then 2 and 48 hours after the procedure, through a ureteral catheter inserted into the excretory axis of the operated kidney. Moreover, we evaluated split renal function of the preserved renal parenchyma by a 99mTC-DTPA renal scintigraphy, performed before surgery and three months later.

RESULTS

AKI was diagnosed, according to internationally criteria, in 3 patients (10.7%). The baseline selective urinary NGAL level was 20.02 ng/ml. This level significantly increased after surgery with a selective urinary NGAL level that reached 56.36 ng/ml (p < 0.0001). Moreover, a significant reduction in 99mTC-DTPA clearance of the operated kidneys after three months was detected (p < 0.0001).

CONCLUSIONS

Selective urinary NGAL assay represent a sensitive biomarker of acute kidney injury after robotic nephron sparing surgery, capable of predicting the functional outcome of the operated kidney.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience

BACKGROUND

Few studies have reported robotic pyelolithotomy (RPL) series; furthermore, the most of all have reported small and single-center series. Herein we report our experience from 70 cases of complex kidney stones treated with RPL at our surgical center; this study reports the largest series of RPL in a minimal invasive experienced center.

METHODS

Between February 2016 and March 2018, 70 patients with complex renal stones (Guy's Stone Score: 4) underwent RPL and included in a prospectively maintained institutional database. Baseline characteristics, clinical data, perioperative data, postoperative data and stone free status were assessed by descriptive statistics.

RESULTS

Of 70 patients, 72.85% presented renal pelvis stones. The mean maximum stone diameter was 33.1±14.5 mm (median 30 mm; interquartile range 22-40 mm). Mean total operative duration was 122.5±34.4 min (median 120 min; interquartile range 105-135 min). In two patients (2.8%), a grade III complications were noted; no major complications (grade IV-V) were noted. The complete SFR, after a single robotic procedure, was 92.8%.

CONCLUSIONS

Our findings suggest that RPL is a safe, reproducible and minimally invasive approach as treatment of large renal stones when endoscopic treatment failed or was not available. RPL permits to achieve an excellent stone free status, in a single definitive procedure.

Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU

INTRODUCTION

Proper management of patients undergoing robotic-assisted urologic and gynecologic surgery must consider a series of peculiarities in the procedures for anesthesiology, critical care medicine, respiratory care, and pain management. Although the indications for robotic-assisted urogynecologic surgeries have increased in recent years, specific guidance documents are still lacking.

EVIDENCE ACQUISITION

A multidisciplinary group including anesthesiologists, gynecologists, urologists, and a clinical epidemiologist systematically reviewed the relevant literature and provided a set of recommendations and unmet needs on peculiar aspects of anesthesia in this field.

EVIDENCE SYNTHESIS

Nine core contents were identified, according to their requirements in urogynecologic robotic-assisted surgery: patient position, pneumoperitoneum and ventilation strategies, hemodynamic variations and fluid therapy, neuromuscular block, renal surgery and prevention of acute kidney injury, monitoring the Department of anesthesia, postoperative delirium and cognitive dysfunction, prevention of postoperative nausea and vomiting, and pain management in endometriosis.

CONCLUSIONS

This consensus document provides guidance for the management of urologic and gynecologic patients scheduled for robotic-assisted surgery. Moreover, the identified unmet needs highlight the requirement for further prospective randomized studies.

Lower urinary tract symptoms and benign prostatic hyperplasia and their impact on quality of life

<em>LUTS</em> is an acronym that refers to <em>symptoms</em> affecting the <em>lower urinary tract</em>, which are very common in elderly subjects (between 60 and 70%), and often associated with, but not always caused by, benign prostatic hypertrophy (BPH). BPH is a chronic condition characterized by an increase in the number of cells, particularly in the transition area of the prostate. BPH involves a compression of the surrounding tissues, consequently obstructing vescical voiding. Nycturia and urgency represent the most prevalent symptoms and those with the greatest impact on quality of life measured as <em>urinary-specific health-related quality</em>. The prevalence of BPH is directly proportional to age; therefore, the absolute number of subjects affected is growing throughout the world. BPH is one of the most common medical conditions affecting those over 50. The overall cost for the diagnosis and treatment of BPH-related LUTS, in the US, has been estimated at approximately 1.1 billion US$/year, compared to total annual expenditure for urological conditions of some 9 billion and this cost continues to increase. The <em>quick prostate test</em>, which was developed by the Italian Urology Society (SIU), is an easy to use instrument that can be utilized in first-level screening for evaluation of the male population with LUTS. This test can be used both in patients not on pharmacological treatment and as a therapy-monitoring instrument. A positive response to one of the questions is sufficient for requesting a more in-depth investigation, which may provide indications on the therapeutic strategy to be taken.

Effect of Tadalafil Once Daily on Penile Length Loss and Morning Erections in Patients After Bilateral Nerve-sparing Radical Prostatectomy: Results From a Randomized Controlled Trial

OBJECTIVE

To report penile integrity measures, including stretched penile length (SPL), from a randomized, double-blind, double-dummy, placebo-controlled trial evaluating treatment with tadalafil initiated after nerve-sparing radical prostatectomy (nsRP).

METHODS

Patients aged ≤ 68 years were randomized after nsRP 1:1:1 to 9-month double-blind treatment (DBT) with tadalafil 5 mg once daily (OaD), 20-mg tadalafil on-demand ("pro-re-nata"; PRN), or placebo, followed by 6-week drug-free washout and 3-month open-label OaD treatment. Secondary outcome measures included the change in SPL from pre-nsRP to the end of DBT (analysis of covariance adjusting for treatment, country, baseline, age, and nerve-sparing score), responses to Sexual Encounter Profile (SEP) questions 1-3 (mixed models for repeated measures adjusting for treatment, country, visit, visit-treatment-interaction, age), and Standardized Morning Erection Question (Cochran-Mantel-Haenszel test adjusted for age and country).

RESULTS

Four hundred twenty-three patients were randomized to tadalafil OaD (N = 139), tadalafil PRN (N = 143), and placebo (N = 141). Greater retainment of SPL was observed with tadalafil OaD vs placebo at the end of DBT (least-square mean [95% confidence interval] difference OaD vs placebo, 4.1 mm [0.4 to 7.8 mm]; P = .032). No significant effects on SPL were found for tadalafil PRN vs placebo, or for the nerve-sparing score. Penile tumescence (SEP1) and ability for vaginal insertion (SEP2) significantly improved vs placebo at the end of double-blind and open-label treatment for patients randomized to tadalafil OaD only. The ability for successful sexual intercourse (SEP3) significantly improved with tadalafil OaD vs placebo only during DBT. The distribution of Standardized Morning Erection Question responses was different at the end of DBT (P = .045); 34.2% of patients on tadalafil OaD, 50.0% on tadalafil PRN, and 56.5% on placebo reported absence of morning erections.

CONCLUSION

These data suggest the early initiation of tadalafil OaD protects from penile length loss and may contribute to protection from structural cavernosal changes after nsRP.

Erectile dysfunction and alcohol intake

The objective of this work is to evaluate in a selection of patients with erectile dysfunction the influence of alcohol consumption and the response to alcohol abstinence with and without sildenafil association. Materials and Methods. In a population of 150 consecutive patients with erectile dysfunction we studied 50 patients aged between 22 and 77 years (mean 56±14 SD). These 50 patients were divided into three different treatment groups and were screened for three different levels of alcohol risk with two questionnaires. All patients were evaluated with an International Index Erectile Dysfunction (IIEF) questionnaire before and after one month of treatment. RESULTS. The 50 patients included 14 patients with high alcohol risk, 34 patients with low alcohol risk and only 2 patients with no alcohol risk. After one month, 29 patients responded to the therapy, and 21 did not respond. The IIEF questionnaire presented a statistically significant difference between the different risk groups before and after treatment (p≤0.05). All the patients were examined with a penile Doppler Ultrasound. Only 10 of them had an abnormal diastolic peak velocity (PDV) and only 1 presented both pathologic systolic peak velocity (PSV) and PDV. These 11 patients did not respond to therapies and 10 of them were at high alcohol risk. The alcohol consumption risk was directly correlated with PDV (p=0.00001; R2=0.4). CONCLUSIONS. The results of this study demonstrated a significant relationship between alcohol consumption and erectile dysfunction. This underlines the important therapeutic issue of alcohol abstinence in treating patients with erectile dysfunction.

Sexual dysfunctions in multiple sclerosis

AIM

The aim of this study was to analyze the sexual dysfunction in patients affected by multiple sclerosis.

METHODS

From January 2005 to December 2007, 221 consecutive patients, 97 women and 124 men, were included in the study. Age range was 20+/-65 years (average 38.77). Fifty-two patients, 14 women (26.9%) and 38 men (73%), among those who have had sexual dysfunctions, showed their will to tackle their problem, and were thus taken into consideration by the Department of Andrology. Sexual activity of these patients has been estimated by self-administered questionnaire, through the International Index of Erectile Function (IIEF) for men and Index of Female Sexual Arousal (IFSA) for women. All 64 patients started a domiciliary therapy with sildenafil 50 mg, and in case of failure, sildenafil 100 mg. Results have been estimated for men according to the IIEF questionnaire and to the answers to the third and fourth question, concerning the capacity to have and keep an adequate erection during a sexual intercourse, and for women according to the IFSA questionnaire and to the answers given to questions number 1, 5, 6, and 10.

RESULTS

Among the 124 male patients, 25 (20.1%) had a serious deficiency of the erectile function (score IIEF<10), 11 (8.8%) had a moderate deficiency (score from 11 to 16), and 20 (16.12%) had a light deficiency (score from 17 to 25). Twenty-five patients affected with serious erectile deficiency, also reported a contemporaneous decrease of libido. Among the 97 female patients, 22 (28.86%) of them reported a serious decrease of the genital sensitivity and of the sexual desire; 22 (22.68%) of them reported instead a serious decrease of the vaginal lubrication; 9 (9.2%) reported a moderate decrease of the sensitivity, and 10 (10.30%) reported a moderate decrease of the vaginal lubrication. According to Disability Scale Expanded Score 52 male patients showed a 2.6 mean score (range 1.5-7); 14 female patients showed a 2.9 mean score (range 3-6). The answers to IIEF questions number three and four, and to the IFSA questions number 1, 5, 6 and 10 reported the achievement and keeping of an adequate erection after a follow-up of 4 sexual intercourse, and lubrication and sensitivity during a sexual intercourse in all the cases analysed.

CONCLUSION

Sildenafil has been effective and safe in the treatment of sexual dysfunctions for both sexes. In all analysed patients sexual deficiency was due to the neurological and central nervous system on which depend different dysfunctions correlated with the extension and the gravity of the multiple sclerosis. IIEF questions number 13 and 14 and IFSA questions number 21 and 22 showed a clear improvement of the sexual life quality of these patients, after sildenafil therapy.

[Tadalafil versus sildenafil citrate in the treatment of ED:Italian patients' preferences and explanatory notes]

This is an open, multicentre, randomized, crossover study having the aim to evaluate the preference for sildenafil citrate or tadalafil in a population of Italian patients affected by ED, and to compare the efficacy and safety of these two drugs. MATERIAL AND METHODS. From October 2003 to November 2004, thirteen Italian centers enrolled ED patients (age >18) being in steady and naïve relation to ED treatment, both through PDE5 inhibitors and any other treatment option. These patients were randomized to sildenafil or tadalafil for 12 weeks, after which they were switched to the alternative treatment for a further 12 weeks. The preference was evaluated through the Treatment Preference Question (TPQ): "During this clinical trial you have taken tadalafil and sildenafil for the treatment of erectile dysfunction. Which medication do you prefer to take for the next 8 weeks of treatment?". Moreover, patients were asked to express their preference as "strong" or "moderate" and to answer some questions to clarify the reasons behind their preference. SEP and IIEF-EF questionnaires were used for a comparison of efficacy. RESULTS. 167 patients were enrolled, 144 of whom completed both treatment periods. On being asked the TPQ, 75% of patients (n=108) decided to continue treatment with tadalafil, in particular because it made it possible to have an erection many hours after taking the medication (first or second preference reason for 64.8% of patients), while 25% (n=36) preferred sildenafil (p=0.001). Both drugs improved the IIEF-EF and SEP scores compared to baseline, with a slightly but significantly greater improvement with tadalafil for both parameters. CONCLUSIONS. Tadalafil and sildenafil are both effective and well tolerated. Most of the patients prefer tadalafil thanks to the possibility of having sexual intercourse many hours after taking the medication.

Sexual dysfunction in patients under dialytic treatment

AIM

Erectile dysfunction (ED) is very common in patients with renal failure, probably as a side effect of long-term treatments and dialysis, among other etiologic factors. Over the last few years, new highly effective oral treatments for ED have been introduced in the market. We designed a prospective trial in 42 dialytic patients with ED, focusing on the therapeutic effect of syldenafil and apomorphine.

METHODS

Forty-two patients aged 57 years (range 34-71), [40 on hemodialysis (HD) and 2 on peritoneal dialysis (PD)] were enrolled in a prospective study comparing sildenafil with apomorphine. After a careful nephrologic anamnesis and uroandrological examination, all patients underwent, before and after each treatment, the International Index Erectile Function (IIEF) test, and the Life Satisfaction test. Expert opinion was based on grading of evidence based medical literature, widespread internal committee discussion, public presentations and debates.

RESULTS

The 2 patients on PD were the only responders to 25 mg sildenafil; 25 patients on HD had a clear improvement of the IIEF score after 50 mg sildenafil administration; finally, 11 patients on HD would benefit only from 100 mg sildenafil; the nonresponders to sildenafil were only 4 patients, having to switch to PgE1. When apomorphine was tested on the same patients, a mild response was seen only in 6 patients at the 3 mg dose. No response was seen in the 2 patients on PD.

CONCLUSIONS

There was a statistically significant difference in the therapeutic role of sildenafil versus apomorphine, the first producing an overall improvement of the IIEF in 90.5% of patients, compared to 14% of the same patients receiving apomorphine (P<0.001).

[La Peyronie's disease: anatomical and functional evaluation using color Doppler echography]

We performed color duplex ultrasound in patients with Peyronie's disease in order to define the anatomy of corpora cavernosa and penile vascular abnormalities. We evaluated 20 patients, affected by Peyronie's disease, using echo-color-doppler after pharmaco-injection of PGE1 and autostimulation. We find that impotent patients had decreased EDV after 30 Minutes and after autostimulation; all patients had a normal PSV. The echo-colo-doppler is a useful tool in the evaluation of the penile vasculature, in patients with Peyronie disease, for its high sensitivity, low invasiveness, and good acceptance from patients. The results of this test could safely guide the therapeutic choice.

[Preoperative staging of prostatic carcinoma: evaluation of the role of transrectal echography]

Radical Retropubic Prostatectomy (RRP) is the choice treatment for localized prostate cancer. Transrectal ultrasonography (TRUS) was used to predict local tumor extension in ninety-one patients prior RRP. In these patients 41% showed histologic evidence of extracapsular spread. These data suggest that ultrasonography is associated with considerable staging errors when used to evaluate men with clinically localized prostate cancer.

[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.

[Echo-guided biopsy of the transitional zone in the diagnosis of prostatic carcinoma]

Approximately 24% of prostate cancer originate in transition zone. To define the indications for transition zone biopsies from April 1994 to February 1996 we evaluated 112 men ranging in age from 56 to 84 years (mean 67.4). 94 patients presented elevated PSA levels and normal rectal examination (24 with negative prior systematic sextant biopsies). A group included 6 patients with palpable nodularity and normal PSA levels. A third group consisted of 12 men with sonographic abnormalities. Of the 112 patients evaluated 38 (34%) were found to have cancer on the prostate biopsies and 7 (18%) were positive only in sample of transition zone biopsies. We conclude that transition zone biopsies don't substantially improve the cancer detection rates in patients with palpable nodularity or sonographic abnormalities but are useful in patients with elevated PSA levels and/or negative prior systematic sextant biopsies.

Compliance to longterm vasoactive intracavernous therapy

From December 1986 to December 1991, 107 patients with organic impotence were advised to intracavernous pharmacological therapy with papaverine. Sixteen patients refused such treatment: 91 patients, after the determination of the therapeutical dose, underwent self injection. The follow up was 30-90 months. Thirty-seven patients (40.7%) withdraw the treatment within 3 months: 3 patients (3.3%) after losing the partner; 9 (9.9%) for intercurrent disease; 23 (25.3%) were unsatisfied for the therapy; 2 (2.2%) regained spontaneous erections. Complications were: local haematomas in 23 (42.6%); prolonged erections in 6 (11.1%); fibrotic changes of the corpora cavernosa in 9 patients (16.7%); liver enzymes changes in 2 (3.7%). The reasons for the low compliance to the intracavernous pharmacological therapy with papaverine were analysed.

Paroxetine in the treatment of premature ejaculation

OBJECTIVE

To test the efficacy and the adverse effects of a new anti-depressant drug (paroxetine) in the treatment of premature ejaculation.

PATIENTS AND METHODS

The study comprised 32 men (mean age 28 years) with premature ejaculation (14 of whom ejaculated before penetration) who were treated with paroxetine (20 mg orally each evening for 2 months). The study group excluded those with neurological and psychiatric disorders, urinary tract infections and drug or alcohol abuse.

RESULTS

After about 14 days, the patients' symptoms improved and all patients reported a longer interval before ejaculation. The adverse effects were sleepiness in 19 patients (61%) and mild sensory confusion in 21 (68%), but only one had to withdraw from therapy. Three weeks after the end of therapy, the premature ejaculation recurred in 28 (90%) of the patients.

CONCLUSIONS

These results indicate that paroxetine is an effective therapy for premature ejaculation. Further studies with different dosages are necessary to decrease the adverse effects and to prolong the efficacy.

Advanced prostate cancer follow-up with prostate-specific antigen, prostatic acid phosphatase, osteocalcin and bone isoenzyme of alkaline phosphatase

We report our experience in the follow-up of 63 patients with advanced prostate adenocarcinoma. We used prostate-specific antigen and prostatic acid phosphatase in 27 patients; in 36 patients we evaluated osteocalcin and bone isoenzyme of alkaline phosphatase, two markers of bone metabolism which seem to be good markers in the follow-up of patients with bone metastases.

[Ultrasonically guided biopsy of the prostate for the diagnosis of carcinoma]

Echoguided biopsy of the prostate is a new method used in the diagnosis of carcinoma. False negatives, which range between 7% and 27% of transperineal biopsies, can be reduced to 11% using ultrasound control. In 50% of cases carcinoma are located in the hypoechogenic area, in 45% in mixed echogenic areas and in 5% in hyperechogenic areas. The diagnosis of carcinoma was performed in 40.7% of patients examined. In conclusion, this method is shown to be a valuable and advisable aid.

Study of mepartricin possible interactions with antilipemic drugs. Controlled clinical trials in patients with benign prostatic hyperplasia

In order to more throughly study mepartricin pharmacodynamic characteristics, 2 groups of 15 patients with BPH and coexistent lipid metabolism disorders were studied in conformity with a sequential experimental design during which also systemic-acting (procetofen) and endoluminal-acting (cholestyramine) fat-lowering drugs were tried. The data obtained confirmed mepartricin specific effect on symptomatology and function in BPH and demonstrated the absence of positive and/or negative pharmacological interactions between the substance in question and the fat-lowering agents tried.