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

The introduction of intracavernosal (i.c.) administration of vasoactive drugs has revolutionized diagnosis and treatment of sexual impotence. This procedure, though, carries some risks and undesired side-effects, such as fibrosis, priapism, hematomas, etc. Thus, at our Centre has been evaluated the possibility of a transdermal (TS), either active or passive, treatment of impotence. In a first trial, double blind crossover, 62 patients have been treated with yohimbine (YOH) as ointment. About 5 mg of the drug were applied at the balanopreputial sulcus, twice daily. In 10 patients YOH was also assayed by HPLC in the blood drawn from the corpora cavernosa after the application of the drug: a rapid adsorption of the drug was demonstrated and a peak value of 58 ng/ml at 25 min. Treatment with YOH was particularly satisfactory in patients with impotence of recent onset and mild degree, that is without major vascular alterations. The active TD drug administration was tested with papaverine delivered with cavernous bodies by a C.T.D.A.S. (Controlled Transdermal Drugs Administration System). Thin layer chromatography has shown the passage of about 10% of patients a relevant amelioration of erectile function was observed.

Some tests are subject to the influence of a special kind of "irreducible" effects which do not satisfy the Central Limit Theorem of statistics, even though they show no systematic character or tendency. These effects especially present when physiological experiments are concerned "in vivo". In such the lack of specific methods to reduce these effects brings about the necessity of special case in minimizing the loss of information. Contained in the experimental data as well as the accumulation of useless information. Recent work has suggested the extensive use of several indexes derived from combination of available variables and their respective mathematic correlation. The information obtained by following this methodology has the character of "working hypothesis" so it needs many favorable confirmation to assess its reliability. It is convenient to analyze a large number of relations in order to emphasize the concordant effects and discord the others. In order to obtain some preliminary indication of the reliability of this procedure we have analyzed some CMG curves in prostatic and non-prostatic subject. The final slope of the curves (urge point) t = dP/dVr has been adapted as an index of the "elasticity" of the bladder; it was compared with the filling volume, the muscular volume and their ratio, i.e. with a geometric index of the bladder shape. The correlation show that the index t can, to some extent significantly represent the mechanical behaviour of the bladder in its physiological condition or when there is a partial obstruction of urine deflection.(ABSTRACT TRUNCATED AT 250 WORDS)

Circumvallate nephro-cystostomy (CNC) provides a subcutaneous connection of a nephrostomy and a cystostomy catheter thus allowing spontaneous micturition. This procedure is suitable for those patients affected by an obstructive nephropathy where it was not possible to insert a double "J" stent or where surgical treatment was not allowed. Patients affected by debilitating disease benefit from these procedure by avoiding problems connected with daily handling of catheter, examples are medications at the insertion site or possible dislodgement of a nephrostomy catheter added to the psychological problems related to carry the urine collection bag. A number of 13 patients have been treated with this method, 5 had monolateral CNC, 8 had bilateral CNC for a total of 21 procedures. All but one cause of ureteral obstruction were neoplastic, the exception being a patient with necrosis of the ureter subsequent to major vascular surgery. CNC had a residence time ranging from 1, 5 to 25 months with an average of 9.8 months. Only in 2 cases it was necessary to remove CNC due to recurrent cystitis and orchitis due to bladder irritation by a cystostomy catheter and for an obstruction which could not be remedied in a patient with necrosis of the ureter. The most important complication, i.e. obstruction, occurred in 4 cases. In the above mentioned case CNC was removed after 9 months of proper performance. In the other 3 cases obstruction occurred after 2, 3, 18 months and in all this cases obstruction was easily removed. Besides obstruction only minor malfunctions were experienced and the procedure was very well tolerated by all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Male impotence is a relatively frequency disease. To define the correct aetiology of this disorder is important to plan a right diagnosis to difference organic, psychological and psycho-organic causes. From June 90 to June 91 fifty-four patients with male impotence of different degree were observed and went through diagnostic investigations. The patients were classified in four groups (A, B, C, D) as clinical results of the pharmacological test (intracavernous injection of PGE1 alpha 15 micrograms). A and B groups showed normal and nearly normal hemogenic finding. C group showed either low arterial flow increase after FIC or venous leakage. D group showed very low haemodynamic increase. The analysis of Eco-doppler studies was performed 5'-10'-20' after intracavernous injection of PGE1 alpha obtaining three haemodynamic markers: the systolic top flow (Vs) the diastolic ending flow (Vd) resistance flow index. The Authors discuss the results obtained considering the Eco-color-doppler the most important stage in the haemodynamic evaluation of sexual impotence.

The Authors report their experience about fifty patients affected with renovascular hypertension, treated by percutaneous transluminal angioplasty (PTA) for stenosis of main renal artery and now studied by Duplex-Scan and Color-doppler. Results, compared with arterial pressure measurements, renography and laboratory renal function evaluation, showed a sensibility of 84%, specificity of 90% and an accuracy of 87.5%. Advantages and limits of Duplex-scan in patients treated by PTA are briefly discussed.

Using the nuclear medicine procedures it is possible to evaluate the renovascular hypertension via the captopril test. Decreased renal blood flow due to stenotic vessel may produce a variety of findings on the renogram using both OIH-I131 and DTPA-Tc99m. Delayed transit time and excretion also may be detected. In this situation the sensitivity and specificity of Nuclear Medicine for RAS detection is very low. Using Captopril test is possible to detect enhanced modification on the shape of renogram due to Angiotensin Converting enzyme inhibition.

Recurrent urethrocele is not often successfully treated surgically because, as it is well known, pre-operative sterilization of the urethrocele is difficult, especially when it is very large. Furthermore the incomplete excision of the corpus callosum, because of the loss of urethral tissue this involves, often leads to post-operative fistulas and stenoses. This is why, very often, there are relapses no matter what technique is adopted. In 1978 both Juraschek and ourselves published a technique, derived from Monseur, in which the urethrocele and the corpus callosum were completely excised. The resulting loss of urethral tissue was remedied with the albuginea from the ventral surfaces of the corpora cavernosa after a 180 degrees rotation of the urethra. The results of this treatment in 41 cases of recurrent urethrocele are given in this paper. The follow-up period for the patients was from 15 to 2 years. Results have been excellent with very few complications (2 post-operative fistulas and 2 urethra stenoses). There have been no relapses.

The combined use of B-mode ultrasonography and doppler (p.w. and/or color doppler) provides a more accurate and detailed study of vascular pathology than B-mode ultrasonography alone. In fact, besides to document the presence of blood flow and to assess its direction, doppler US provides a quantitative evaluation of blood flow. Chromatic codification of blood flow (usually red if flowing towards the probe, blue if flowing away from the probe and yellow or green in the case of turbulence) permits to assess the presence of blood flow even in areas where a vessel cannot be depicted by B-mode ultrasonography. In fact in the study of blood flow to the kidney it's possible with color-doppler to visualize not only the main renal arteries but segmental-intraparenchymal arteries too; that is very useful in the detection of rejection of allograft. In renal artery, blood flow presents a pattern of low resistance: a brief systolic phase followed by a longer diastolic one, without inversion of flow. In renal vein, blood flow is, on the contrary, continuous. The main disorders of the kidney and urinary tract, which can be detected by color doppler are the following: renal-vascular hypertension, rejection of allograft, renal vein thrombosis, portal hypertension with spleno-renal collateral channels, disorders of ureteral motility, space occupying lesions, medical nephropathies and obstructive uropathies. Sophisticated analysis of the flow pattern to the kidney with color doppler, by some doppler sonographic parameters (resistance index RI, pulsatility index PI), in these disorders adds a functional element to the traditional ultrasonographic imaging with a better characterization of the disease.

Seventeen patients submitted to radical cystectomy and orthotopic bladder replacement according to Reddy's technique were studied at the 1, 3, 6 and 12-month, then annually follow-up by physical examination, intravenous pyelogram, cystourethrography, suprapubic and transrectal ultrasonography and complete urodynamics. Sixteen patients (94%) reported day-time urinary continence and twelve patients (70%) day-time and nocturnal continence. Cysto-manometry showed a mean bladder capacity of 450 cc with a maximal endocavitary pressure of 40 cm. H2O and satisfactory peak flow rate. Vesico-ureteral reflux was never detected at roentgenography. Ultrasonography may be useful in the study of a possible reflux or stenosis of the neovesico-ureteral junction by detecting renal scars or dilatation of the renal cavities. Sovrapubic ultrasonography can quantify the capacity of the neo-bladder (300-600 cc), study its shape, walls and contractions that do not cause the involuntary opening of the neo-bladder neck. Transrectal ultrasonography studies the bladder neck shape and its dynamic function. Residual urine volume never exceeded 50 cc. Ultrasonography demonstrated its effectiveness and reliability and limited the application of more invasive roentgenographic procedures.

There is a long term interest in noninvasive Doppler (Duplex Doppler, Color Doppler) methods to screen patients with reno-vascular hypertension resistant to medical therapy. Doppler criteria for the diagnosis of renal artery stenosis in native kidneys vary (peak systolic velocity exceeding 100 cm/sec; RAR (Renal Aortic Ratio) exceeding 3.5; Doppler shift frequency exceeding 6-8 KHz; dampened peripheral waveform; lack of signal in complete occlusion). When the vessels are adequately visualized (about 40% of cases) sensitivity and specificity are quite good (80-90%). In the transplanted kidney Doppler diagnosis of renal artery is easier (diagnostic accuracy about 90%). The diagnostic criteria have been well codified (Doppler shift of 7.5 KHz at an insonating frequency of 3 MHz).