Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia
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Penile fracture is a serious urological condition that requires surgical repair. We report a case of a penile fracture after traumatic event where sonography was performed and demonstrated the exact site of the rupture in the tunica albuginea and the urethral integrity.
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Arch Ital Urol Androl · Jun 2002
ReviewManagement of clinical stage I testicular pure seminoma. Report on 42 patients and review of the literature.
Testis cancer is the most common tumor detected in men aged from 20 to 35 years accounting for 1-2%. About 20-30% of patients presenting with clinical stage I pure seminoma of the testis, which accounts for 45-50% of all germ cell tumors, present with occult metastases in the retroperitoneal lymph nodes. Currently, treatment options for clinical stage I seminoma include adjuvant radiotherapy (RT) as well as surveillance and adjuvant single agent chemotherapy. Herein, we review our experience in the management of 42 patients with clinical stage I pure seminoma of the testis and review the literature concerning this topic. ⋯ Adjuvant radiotherapy (RT) is a safe standard of care in controlling microscopic retroperitoneal disease in patients with clinical stage I seminoma. About 3 to 5% of patients undergo relapses, mostly after the first 18 months after orchiectomy. Overall cause-specific survival rates range between 96% to 100%. An alternative optional treatment for compliant patients presenting with low risk factors for relapse is surveillance with recurrences rates ranging between 15% to 20%. Surveillance avoids unnecessary treatment in about 80% of patients, thus it could be offered as a safe alternative option to adjuvant RT since imaging detects relapses at their early stages. Adjuvant chemotherapy with 1 or 2 courses of single-agent carboplatin is being investigated as an alternative adjuvant treatment to RT or surveillance in patients with moderate to high risk factors for relapse. The treatment is well tolerated and recurrence rate is 1%.
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Arch Ital Urol Androl · Jun 2002
ReviewManagement of testicular seminoma advanced disease. Report on 14 cases and review of the literature.
About 25% of testicular seminomas present with advanced clinical stage disease. The retroperitoneal lymph nodes are more likely to be involved (20%) than distant organs (5%). Herein we review our experience in the management of 14 patients with clinical stage II pure seminoma of the testis and review the literature concerning this subject. ⋯ Radiation therapy is the standard of care in managing seminoma small bulk retroperitoneal disease including substages IIA and IIB. Overall toxicity of RT is mild and treatment is well tolerated. After RT, about 20% of patients may undergo relapses. Chemotherapy is the choice treatment for advanced seminoma presenting with clinical stage IIC-III disease; recently, it has also been advocated for stage IIB when presenting with multiple small lymph nodes. Carboplatin and cisplatin are the most effective agents with complete response rates of 89-91%. Patients developing progressive disease after first-line chemotherapy undergo combined salvage chemotherapy with cisplatin, ifosfamide and vinblastine with complete response rate of 83%. Patients presenting salvage chemotherapy failure are treated with high-dose chemotherapy associated with autologous bone marrow transplantation. Residual retroperitoneal masses after chemotherapy for advanced seminoma may be assessed by imaging as poorly or well defined. Surveillance is indicated for residual masses smaller than 3 cm as well as for poorly defined masses equal or greater than 3 cm. Well defined masses equal or larger than 3 cm are treated with surgery or RT. Ongoing clinical trials for testicular germ cell metastatic disease are focused on reducing toxicity without compromising efficacy as well as exploring new salvage strategies and improving the prospect of cures and survival rates.
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Arch Ital Urol Androl · Jun 2002
Decrease of ultrasound estimated bladder weight during tamsulosin treatment in patients with benign prostatic enlargement.
The noninvasive method for estimating bladder weight (UEBW, Ultrasound Estimated Bladder Weight) can be used as a measure of bladder hypertrophy and may have clinical use for evaluating intravesical obstruction in male patients. The aim of this study was to assess whether, in patients with bladder outlet obstruction (BOO), tamsulosin treatment produced any significant change in UEBW. ⋯ The results of this study suggest a significant change in UEBW during tamsulosin treatment. The change observed might be suggestive of a therapeutic effect of tamsulosin on the detrusor muscle. Further and more extensive studies are needed in order to confirm a possible therapeutic effect of tamsulosin on the detrusor muscle.
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The rate of urinary incontinence after prostatectomy, as reported in several studies, varies between 0 and 88%. In the last years, pelvic floor rehabilitation in the women stress incontinence has been strengthened, with a great amount of clinical studies and results. Recently, the rehabilitation treatment has been studied in men who underwent a radical prostatectomy. The Cochrane Database of Systematic Reviews recently published the "Conservative management for post prostatectomy incontinence". The aim of this study was to determine the effects of conservative management in post prostatectomy urinary incontinence. Randomized or almost-randomized trials were analyzed up to January 1999; five studies were included, with the following results: 1. Pelvic floor muscle training versus no active treatment. Two trials compared pelvic floor muscle training with patients in a control group. In both groups there was a clinical improvement, especially in the first months after prostatectomy. The results of the two studies suggest a benefit in the treated group, even if not statistically significant, mainly in the first months after surgery. 2. Pelvic floor muscle training + biofeedback versus no active treatment. The treated group regained continence in shorter time, with decrease of incontinence episodes, of urinary frequency, of the quantity of urine loss; these data were not statistically significant. 3. Pelvic floor muscle training + rectal electrical stimulation versus no active treatment No detectable differences among the two groups, either in number of men still incontinent, and in Pad-test results. 4. Pelvic floor muscle training + rectal electrical stimulation + biofeedback versus no active treatment. Pad-test evaluation was similar in the treated and in the control group; no other outcomes were described. 5. Pelvic floor muscle training + rectal electrical stimulation versus pelvic floor muscle training. There was a progressive improvement in three months of rehabilitation, even if not statistically significant. All the studies showed improvement of urinary incontinence in men, independent of their trial allocation (treatment or control group). After an initial period of rapid improvement, continence improves even after the first three months, so that only 15-20% was still incontinent by six to twelve months. ⋯ in the post-operative period, a supportive and educative approach is recommended to reduce the duration and the degree of urinary incontinence. Spontaneous recovering occurs particularly in the first three months: it is maintainable a delayed rehabilitation management, with intensive rehabilitation treatment for men with persistent urinary incontinence. Rehabilitation seems to be more effective in the first four months after surgery. Even the AHCPR Guideline recommends a behavioural, rehabilitative and pharmacological treatment. Research must be improved. Limits of the studies are: small sample sizes, incomplete randomisation--necessary to avoid sample "contamination"--, definition of the best timing for treatment; trials could be restricted to men with persistent urinary incontinence, or could compare early treatment with delayed more selective treatment. This management is intensive and resource-dependent; it may be difficult to justify it, unless it proves evidently effective. In our clinical-therapeutical experience, patients undergo a physiatrist examination within 10 days after catheter removal. The clinical examination includes: full history, self-evaluation questionnaire, strength (PC test: 0-5 by digital anal control), perianal sensibility, anal sphincter tone, presence of muscle synergies. The rehabilitation team immediately enrolls the patient, with an educative-behavioural and rehabilitative approach: men are asked to fill a voiding diary, and have a bladder training and a first pelvic floor muscle training, with written instructions. Patients must know and share the therapeutical project. A second clinical evaluation occurs after three months: if urinary incontinence persists, the patient is submitted to complete rehabilitation: *Urinary incontinence + absence of muscle contraction (PC = 0/1): pelvic floor muscle training and rectal electrical stimulation; *Urinary incontinence with PC test > 1: pelvic floor muscle training and even biofeedback (for those with poor self muscle consciousness). Frequency of treatment: 2-3 times a week. The aim of the treatment is to enable consciousness of pelvic muscles and to strengthen perineal function.