Intravesical vanilloids and neurogenic incontinence: ten years experience.

Introduction: In this study we critically review our '10-year' experience with intravesical vanilloids (capsaicin and resiniferatoxin) in the treatment of neurogenic incontinence, addressing the issue of their introduction into daily clinical practice.

Materials And Methods: From July 1992 to June 2001, 54 patients suffering from detrusor hyperreflexia, due to spinal cord injuries, received intravesical instillation of capsaicin, and from January 1995 to June 2001, 47 patients received intravesical instillation of resiniferatoxin (RTX) in order to treat bladder dysfunction and symptoms. All patients presented detrusor hyperreflexia refractory to oral and/or intravesical oxibutynin and they displayed high-voiding pressure associated with frequent urine leakage.

[Recent advances in diagnosis and treatment of varicocele. Is there an age limitation for surgical treatment?].

In this paper we examined some data from the literature about sperm improvement in patients operated on for varicocele in relation to their age. Furthermore we recalled 66 patients ageing more than 30 years at the operating time, to evaluate the sperm quality and fertility after the operation. We were looking for some criteria about the indications for surgery in varicocele patients correlated with age and degree of the pathology.

3-month formulation of goserelin acetate ('Zoladex' 10.8-mg depot) in advanced prostate cancer: results from an Italian, open, multicenter trial.

Objectives: To determine the endocrine effects, efficacy and tolerability of the 3-month formulation of goserelin acetate ('Zoladex' 10.8-mg depot; 'Zoladex' is a trade mark of the AstraZeneca group of companies) in the treatment of patients with advanced prostate cancer.

Methods: Between February 1996 and October 1997, this open, multicentre study enrolled 120 patients with locally advanced (T3/4) or metastatic (N+ or M1) disease, or an increase in prostate-specific antigen (PSA) level after radical prostatectomy.

Quality of life assessment in patients who undergo sacral neuromodulation implantation for urge incontinence: an additional tool for evaluating outcome.

Purpose: We investigated the impact of sacral neuromodulation on quality of life and assessed the importance of quality of life for determining the success of sacral neuromodulation in patients with detrusor hyperactivity, including instability and hyperreflexia. We also compared it with parameters documented in a voiding diary.

Materials And Methods: From May 1998 to December 2000, 82 female and 31 male patients 17 to 79 years old (mean age 51.

Urodynamic and clinical evidence of acute inhibitory effects of intravesical nociceptin/orphanin FQ on detrusor overactivity in humans: a pilot study.

Purpose: Management of neurogenic incontinence is complex and available treatments are not satisfactory. Nociceptin/orphanin FQ, a recently discovered neuropeptide, has been reported to inhibit the voiding reflex in the rat. These experimental results prompted us to investigate the urodynamic and clinical effects of intravesical instillation of nociceptin/orphanin FQ in humans.

Neuromodulation for fecal incontinence: outcome in 16 patients with definitive implant. The initial Italian Sacral Neurostimulation Group (GINS) experience.

Purpose: Sacral nerve modulation appears to offer a valid treatment option for some patients with fecal incontinence and functional defects of the internal anal sphincter or of the striated muscle.

Methods: Sixteen patients with fecal incontinence (4 males; mean age, 51.4 (range, 27-79) years) with intact or surgically repaired (n = 1) anal sphincter underwent permanent sacral nerve stimulation implant.

Chronic sacral neuromodulation in patients with lower urinary tract symptoms: results from a national register.

Purpose: The Italian Register was created in February 1997 to collect the national results of sacral neuromodulation. All Italian centers at which sacral neuromodulation is performed were invited to participate in our study. We present the results from retrospective and prospective registers.

Intravesical resiniferatoxin for the treatment of hypersensitive disorder: a randomized placebo controlled study.

Purpose: Present therapeutic approaches to control hypersensitive disorder of the lower urinary tract and bladder pain are clinically and scientifically unsatisfactory. We performed a randomized placebo controlled study with followup after 1 and 3 months using intravesical resiniferatoxin to treat hypersensitive disorder and bladder pain.

Materials And Methods: We prospectively randomized 18 patients into 2 groups to receive a single dose of 10 nM.

Urodynamic assessment during intravesical infusion of capsaicin for the treatment of refractory detrusor hyperreflexia.

Purpose: Parameters to predict outcome and the urodynamic effects during infusion of capsaicin, seem not to have been assessed in patients with chronic cord injury. We monitored bladder activity urodynamically during infusion of high dosage of capsaicin.

Material And Methods: Thirty patients, 18 women and 12 men (average age 29 years, range 20-59 years), suffering from chronic spinal myelopathy, who presented a refractory detrusor hyperreflexia, were studied.

[Malformations of the scrotum and its contents].

To introduce we report the embryological origin of the male genitals and we present the endocrine control of the sex phenotypic differentiation and the most important features of the sexual differentiation abnormalities (ambiguous genitalia of newborn, gonadal dysgenesis, chromosome anomalies). Subsequently we report the classification of cryptorchidism and its correlation with hormonal and histological abnormalities. Furthermore we tried to expose the various different thoughts about testicular descent, anomalies associated with cryptorchidism and implications with malignant degeneration and infertility.

Intravesical resiniferatoxin for the treatment of detrusor hyperreflexia refractory to capsaicin in patients with chronic spinal cord diseases.

Objective: Resiniferatoxin (RTX), a substance isolated from some species of Euphorbia, a cactus-like plant, shows pharmacological effects similar to those of capsaicin. We have studied the possibility of treating detrusor hyperreflexia refractory to intravesical capsaicin in patients with chronic spinal cord injuries, thereby providing insight into the mechanism of action of RTX on sensory neurons and its possible future pharmacological and clinical use.

Materials And Methods: RTX saline solution (30 ml at a concentration of 10(-5) M) was instilled into the bladder of 7 patients with detrusor hyperreflexia, refractory to intravesical capsaicin therapy, and left in place for 30 min.

[Orthotopic urinary diversions: the Paduan ileal neobladder. Experience at the Urologic Division of Magenta].

We refer our experience about continent ileal orthotopic bladder in male patient with bladder tumor we report our selections criteria, with particular attention about technical point of view. We show the results, early and late complications.

[Management of sexual dysfunction in spinal cord injury].

In this paper we tried to report the sexual life aspect of spinal cord injury (SCI) patients and to explain how it should be treated in diagnostic and therapeutic pathways. We explain the sexual life alterations of male and female SCI patient and we report some dates about our experience.

Urolume in urethral stenosis: Italian Club of Minimally Invasive Urology experience.

A multicenter study of the patients in whom the Urolume has been implanted has been among the actions undertaken by the Italian Club of Minimally Invasive Urology (UMICLUB). For each patient, a computer information format has been prepared containing evaluation data related to the preoperative period, the endoscopic procedure, and follow-up. The collected data were computerized through unifunctional and multifunctional analysis.

[Post-traumatic penoscrotal avulsion: cosmetic and uro-andrologic evaluation after surgical reconstruction].

A case of surgical reconstruction after penoscrotal skin avulsion is described. Penile coverage was gained by two full thickness grafts helicoidally placed to avoid retractions. Scrotal reconstruction was carried out in two steps, after testis subcutaneous implantation, with axial flaps expanded in abdominal region.

[Anti-sperm antibodies in dysspermia in spinal cord injury patients].

A relatively uninvestigated area of reproductive physiology is the changes of sperm quality in the anejaculatory man. The retention of sperm cells may result in increased pressure in the genital tract, initiating an autoimmune response to sperm as seen in cases of congenital absence of the vas deferens and vasectomy. Reports on this matter are very contradictory.

Transcutaneous minoxidil in the treatment of erectile dysfunctions in spinal cord injured men.

We have tested the erectile effect of a topical applied drug (Minoxidil) in 15 spinal cord injured men. Minoxidil exerts a direct relaxant effect on arterial smooth muscles. This topical vasodilatory agent (1 ml of a 2% solution) was applied on the skin of the penile shaft.

[Anamnestic criteria for sexual evaluation in the andrological field].

What is the cause for impotence? In the recent years psychological studies have accredited some insights and modern neurological and vascular technologies have identified some previously idiopathic or misdiagnosed causes. The postulated ratio of psychogenic to organic dysfunction varies from 20:1 to 1:7 and this ratio may vary form one cultural area to the next. The authors underline that the main characteristic of the groups of males complaining of erectile dysfunction is heterogeneity and that the diagnostic procedure for finding the correct etiology may be rather cumbersome.

[Intracavernous injections of prostaglandin E1 in the treatment of erection disorders].

Vasoactive drugs have been widely used for the treatment of impotence in the last years. Recently Prostaglandin E1 has been employed with success as a therapy in erection problems. The Authors have treated with Prostaglandin E1 209 patients complaining erection failure.

Nerve conduction velocity of dorsal nerve of penis: a modified technique.

The dorsal nerve of the penis is involved in sexual function. Until now, the nerve conduction velocity (NCV) of the dorsal nerve of the penis has been measured by dividing the distance between the stimulating and the recording electrodes by the latency to the negative peak of the action potential. With the penis stretched with a 1 lb weight, the NCV in normal men was 33 m/sec +/- 3.

Office treatment: intracavernous injections of prostaglandin E1 (PG E1) and improvement of spontaneous erections.

The Authors evaluated 48 patients with erectile dysfunctions, either psychogenic or neurologic or with vascular etiology. The experience confirms that PG E1 is able ti improve erection, mainly in case of psychological and vascular problems. The drug used is useful for the office treatment, since it has such a low incidence of side effects.

[Renal adenocarcinoma: 20 years of surgical experience, 1970-1990].

Epidemiology, diagnostics, staging, surgical procedure and survival data of 219 patients with renal cells carcinoma are reported (1970-1990). Diagnosis is based on Tc and angiography. Possibly in the future high sensitivity methods like Magnetic Resonance could limit the use of invasive techniques.

[Prosthetic implants for penile induration].

From 1982 to 1988 we have evaluated 283 patients affected by Peyronie's disease. 81 of these complained erectile disfunction. Semirigid penile prosthesis were inserted in 38 patients with severe induratio penis plastica.

Clinical, urodynamic and neurophysiological findings in patients with neuropathic bladder due to a lumbar intervertebral disc protrusion.

Unlabelled: Sacral nerve roots are affected in 1 to 15% of reported cases of lumbar disc protrusions (mainly posterior) (Scott, 1965). Urinary retention is the commonest symptom. In the last 6 years, we have observed 22 patients (18 males and 4 females) with a neuropathic bladder due to this condition in the acute phase.

Prostaglandin E1 in the therapy of erectile deficiency.

We describe the management of 47 patients suffering from erectile dysfunction with prostaglandin E1. Positive response was reached in 38 patients. Self-injection was proposed and accepted by 30 patients.