Archivio italiano di urologia, nefrologia, andrologia : organo ufficiale dell'Associazione per la ricerca in urologia = Urological, nephrological, and andrological sciences最新文献

We describe our experience of surgical therapy for vasculogenic impotence, using a technique of arterialization of the deep dorsal vein. This technique was chosen because vascular anastomosis can easily be performed, and because of the possibility of inducing haemodynamic mechanisms which favour the maintenance of rigidity, using venous arterialization. The operation was performed on 22 selected subjects with positive results. 12 patients (55%) reported erections which enabled them to have satisfactory sexual relations one year after follow-up. From the data reported we can conclude that penile revascularization, using the technique of arterialization of the deep dorsal vein, in well selected cases of vasculogenic impotence, should be considered a valid alternative to a penile prosthesis implant.

The Authors report a rare case of oncocytoma in a horseshoe kidney. The diagnostic path needed to assess the precise anatomy of the malformation and tumoral staging is out lined. Oncological problems dealing with oncocytoma are further discussed, together with the technical and surgical issues pertinent to the clinical case.

The surgical treatment of vascular impotence has evolved as our understanding of the haemodynamics of erection advanced. In the early Seventies the direct revascularization techniques which create an anastomosis between an artery and the corpora cavernosa came to be so much in use that an era of so-called "pure arteriogenic impotence" seemed to be dawning. An arterial role in the pathogenesis of importance gained increasing support during that decade, as the use of a number of techniques for the diagnostic assessment of penile haemodynamics becomes widespread (Doppler ultrasound, determination of the penile-brachial index, selective hypogastric arteriography, penile radionuclide scan, penile plethysmography). Corpora cavernosa-direct revascularization techniques, such as the Epigastric-Corporal and Femoro-Corporal trans-Saphena anastomoses, were developed, the latter being proposed by Michal in 1973. By the late Seventies, however, most Authors had abandoned these techniques. Severe haemodynamic side-effects, such as uninterrupted intra-cavernous high pressure and attendant permanent tumescence of penis, were found to induce the microfibrosis of erectile tissues and the thrombosis at the site of the anastomosis. In this period, "venous leakage" became, with the advent of cavernosography, a recognized factor in the pathogenesis of impotence. However, the concept of venogenic impotence, characterized as it is by transient erection, and featuring pathological cavernosograms as well as high cavernometric figures, belongs more appropriately to a clinical syndrome and is, therefore far from being unambiguous. Arterial-arterial bypass and selective veins ligation were then introduced to treat cases of "pure" arteriogenic or venogenic insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Individual, marital or familiar problems, life circumstances, lack of libido, anxiety or sex identity fragility or immaturity may determine or make worse the erectile deficit. A thorough diagnostic work up is essential for the prognosis and the choice of the more fitting therapy. Emotional and cognitive understanding of the psychogenic background of the symptom is combined with behavioral therapy based on modern principles of neuroriabilitation.

Surgical therapy is the only useful correction in congenital fibrosis or in hypoplasia of the 'corpora cavernosa', associated with hypospadia or not. On the contrary in not congenital fibrosis of the 'corpora cavernosa' (Peyronie's disease, consequences of priapism, or trauma, complications of pharmaco-prosthesis) are allowed pharmaco-physical treatments (infiltrations, ionophoresis, ultrasound, laser). Pharmaco-physical therapy can be used as the only treatment, which is often resolutive, but it is also useful before or after the surgical operation of the 'corpora cavernosa'. These diseases can give disorders of the erection, until complete impotence is reached. In fact the erectile tissue can't expand, because of the rising fibrosclerosis. Among acquired fibrosis of corpora cavernosa I.P.P. has surely the greatest recurrent: the consistency of our series made possible to achieve significant results with a unified therapeutical protocol. The same management was applied in other, less frequent, penile fibrosis, always with full positive results even if on a small number of patients. We are evaluating a new drug (defibrotide) in the treatment of cavernosal vasculitis. Another one (hyaluronidase) associated to orgotein, could improve its effect against inflammation especially in chronic evolutions. Besides new treatments, we emphasize the prevention of iatrogenic fibrosis with particular regard to cavernous pharmaco-infusions by autoinjections: the training of the patient and the safety of the autoinjectors must be carefully checked by the andrologist to decrease a large amount of complications.

In the therapy of vasculogenic impotence, the Vacuum Device has been proposed up to now as an "external" prosthesis device with the aim of obtaining a penile erection of sufficient rigidity for penetration, in patients afflicted by vascular or neurological disorders. In the eighties, the experience gained with the use of Intra Cavernous Injections (C.I.D.) (using papaverine, phentolamine and prostaglandin), demonstrated not to be an exclusively palliative therapy ("pharmacological prosthesis"), but to represent as well a sort of "vasoactive exercise" of the erectile tissue. In the nineties, many wondered what could be a valid alternative to the C.I.D. Taking this into consideration, we modified the method of application of Vacuum Therapy. The device was used once a day without the constrictive band applied to the penis root, in order to generate a passive action on the erectile tissue, a sort of "stretching" for the smooth muscle fibers. From January 1990 to December 1991, we treated 78 pts. afflicted by erectile failure. The patients were divided into 3 groups (26 each) of distinct therapy: the first was treated weekly with only endocavernous papaverine administration (20 mg.), the second underwent daily Vacuum Therapy exclusively (10'-15') and the third received a combined therapy: Vacuum Device, daily and C.I.D. with Papaverine (20 mg.) once a week. The results of this treatment are as follows: the patients who underwent Vacuum Therapy daily (2nd and 3rd groups) showed, at the end of the treatment (6 months), a significant improvement in spontaneous erectile ability (14 Pts.-53.8% in the 2nd group; 17 Pts-65.3% in the 3rd group).(ABSTRACT TRUNCATED AT 250 WORDS)

In 1982 Virag presented the initial experience of use in diagnosis and treatment of impotence. PGE1 has been showed a safe and effectiveness drug. From september 1989 to october 1991 210 patients with erectile disorders were managed by I.C.I. with PGE1 with minimal side effects.

After having emphasized the importance of interdisciplinary diagnostic approach to the sexual impotence as a symptom and having made some comments about the erection's physiology, the Authors, according to their experience, take drugs into consideration for elective treatment of sexual intercourse.

Increasing interest has developed in recent years about the preservation of sexual function after urological surgery. The pelvic plexus which is formed by parasympathetic visceral efferent preganglionic fibers that arise from the sacral center provides autonomic innervation to the corpora cavernosa. The cavernous nerves emerge from the pelvic plexus and then travel along the posterolateral portion of the seminal vesicle and prostate and then along the membranous urethra. The preservation of the nerve supply of the corpora during urological and pelvic procedures is of vital importance to preserve potency.

Male sexual activity is in all mammalian species, included man, androgen-dependent. The role of testosterone (T) starts already during intrauterine life. It continues thereafter, inducing the development of sexual secondary characteristics and libido. Therefore T has represented the "classical" treatment of male sexual dysfunctions. In the therapeutic routinary use T is employed ad ester, like cipionate, enanthate and other i.m., undecanoate per os. When a pituitary defect is present and the testicular receptors are functioning a treatment with HCG can be employed.