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 authors report a review on the L-carnitine effects on the male genital tract. L-carnitine represents a cofactor in the transport of long chain fatty acids inside mitochondria and their subsequent oxidation. Therefore, its main role is that of intramitochondrial vehicle of acyl groups. In particular, the effects of L-carnitine on the male genital function seem connected mainly with the high concentration of L-carnitine in the epididymis; the uptake of the L-carnitine from the blood is an active, in part androgen-dependent, mechanism. Moreover, epididymal spermatozoa are able to concentrate L-carnitine (while they become progressively more impermeable to such a substance) during their passage from the caput to the cauda epididymis. The main function of the L-carnitine in the epididymis is to give to the spermatozoa an energetic substrate. In fact, this function should be of great importance since the epididymal spermatozoa employ fatty acid oxidation for their energy metabolism; on the contrary, the ejaculated sperm employ glycolytic process. As a consequence of the above-mentioned effects of L-carnitine the dosage of this substance in the evaluation of the integrity of the processes of maturation of the spermatozoa was proposed. Finally, there is growing interest in the use of L-carnitine as a therapeutic tool in some forms of male infertility.

Renal emphysema is a rare and severe infection, that constitutes two clinical entities: emphysematous pyelonephritis and emphysematous pyelitis. We report a case in which the gas is localized both in the collecting system and in the parenchyma of the kidney. In our experience the percutaneous renal drainage has revealed to be able to dominate the infection but not to preserve renal function.

The coagulative system has an important role on haemodialysis and on atherosclerosis genesis; in particular the platelets are key elements of the coagulation and of atherosclerosis phenomena. Alterations of the coagulative system and increase risk of developing atherosclerosis are reported in the aging. We in this paper, report the results obtained studying the influence of the interaction between the elderly and dyslipidemia on the coagulative system in haemodialyzed patients. The obtained data showed that the hypertriglyceridaemia in interaction with the elderly accelerates and increases platelet aggregation after stimulation by ADP, Epinephrine and Collagen. So, it is important to consider hypertriglyceridaemia and age as thrombogenic factors and atherosclerosis accelerating factors in haemodialyzed patients.

We assessed the value of ultra sonography in diagnosis and grading the alterations in canalization of seminal pathways. After clinical examination and semen analysis, we studied 4100 patients by scrotal US with sector mechanical (7.5 MHz) probe with water bag and by transrectal US for prostatic vesicular region evaluation with 5-6.5 MHz linear probe (lately we used biplanar probe). In three cases, we performed us guided aspiration and contrast media injection of prostatic cavity. In 63 cases (1.53%) we found developmental malformations of seminal vesicles. The abnormality was bilaterally in 33% and it was associated with malformations of urinary tract in 17.46%. Other malformations were found in 0.12% cases. Ultrasonography was always able to establish obstruction level and type, and the possible associated abnormalities. US permitted to avoid or to restrict testis biopsy or vasoseminal vesiculogram. Ultrasonography is eventually able to guide second level diagnostic examination (aspiration biopsy and contrast media injection of prostatic cysts) and endourethral approach to drainage.

After a brief summary about surgical technique of radical prostatectomy and its indications in the different stages of prostatic cancer, the Authors describe complications and surgical sequelae of this operation. The Authors report a brief series. It is composed with 13 patients. Their have been submitted to radical prostatectomy for prostatic cancer between January 1989 and September 1991. Pathological stage was B1 in 6 patients, B2 in 2 patients, C1 in 4 cases and C2 in 1. Particularly the role of ultrasonography in detection and follow-up of early complications such as lymphocele, pelvic hematoma and anastomotic urine leakage is stressed. Transrectal ultrasound is especially useful in the detection of urine leakage from vesico-urethral anastomosis. This technique is compared with traditional cystourethrography and advantages and disadvantages of the two techniques are discussed. Later complications of radical prostatectomy are anastomotic stenosis, pelvic recurrences, nodal or parenchymal metastasis, urinary incontinence. The role of transrectal ultrasound in the detection of anastomotic strictures is stressed, especially when the study is done during micturition. Transrectal ultrasound is not so satisfying in the detection of pelvic recurrences, especially if they are smaller than 1 cm. In case of large masses digital examination is diagnostic itself. At last the Authors describe urinary incontinence and its etiology as a complication of radical prostatectomy. Particularly a surgical technique for vesico-urethral anastomosis proposed by Rocca Rossetti and its value in post-operative continence is described. The Authors show the results of transrectal ultrasound in the detection of striated urethral sphincter and its function after radical prostatectomy.

Us-Doppler examination of the native kidney gives more detailed information on nephrological vascular disease. Since there is a close connection between renal functional units (nephrons) and vascular and interstitial compartments, alterations in intrarenal flow will obviously occur in all types of medical nephropathy, irrespective of the origin of the anatomopathological damage. Altered intrarenal flow occur with increased vascular impedance, in turn related to an increased resistance index (RI). In nephropathy with dilatation, the RI can distinguish obstructive from non-obstructive dilatation (high and normal RI, respectively). Personal experience of 80 kidneys with nonobstructive medical nephropathy has shown a good correlation between increased RI and deterioration of renal function, demonstrating that, renal function being equal, RI is higher in Vascular than Tubulo-interstitial and Glomerular nephropathies. For medical nephropathy of transplanted kidneys, Us-Doppler evaluation can be combined with conventional Doppler for diagnosing acute rejection. In this series, an elevated RI (0.90) is highly predictive of acute rejection (92% specificity) but has low sensitivity (30%). At the threshold value of RI = 0.80, sensitivity is 66% and specificity is 78%. However, it is considered that far more reliable information is obtained if Doppler examination is combined with conventional U.S. morphology.

Modern technology allows us to study the renal vascular diseases by means of many diagnostic procedures. In the past the main diagnostic technique was Urography, whereas Angiography were performed only in few selected cases. The new Imaging Techniques totally changed the diagnostic approach to this kind of diseases. Today in fact Echo-Color-Doppler and Nuclear Medicine are the early diagnostic techniques to be performed. Actually only few selected patients undergo Angiography, not the conventional one but the Digital; this new technique, in fact, in case of renovascular Hypertension is not only of diagnostic value but is often the definitive therapy.

Vesiculodeferentography (VDG) plays an important role in diagnosing male infertility and staging of prostatic cancer; the techniques of performing the examination are, today, well codified: 1) retrograde, by endoscopic cannulation of ejaculatory ducts; 2) anterograde, by cannulation of the deferent duct surgically prepared at the scrotum. In order to avoid the difficulties of the first method and the risks in the second (like stenosis and fibrosis of the deferent duct) we propose a new simple and safe method based on the direct transperineal puncture of the seminal vesicle under direct echographic control with a transrectal probe. We have studied 16 patients, mainly in order to stage prostatic cancer; the procedure was easy to perform, well tolerated and without consequences at seminal level. It required only 30 minutes, without anaesthesia and with a very low cost. The method permits a clear visualisation of anatomical structures and of possible pathologies with particular reference to vesicular invasion by a prostatic cancer.

The authors refer on the pathogenesis, diagnosis and therapy of bladder diverticula, with particular reference to the endoscopic compression technique performed in 35 patients. The authors stress the usefulness of bladder ultrasonography in the follow-up of operated patients. Results are comparable to those obtained cystography.

To study the effects of deep freezing on the energy metabolism of human spermatozoa, we investigated, by cytochemical quantitative methods, cytochrome oxidase and lactate dehydrogenase activities of fresh and frozen human spermatozoa during in vitro capacitation. Fresh and frozen human spermatozoa were incubated in Biggers, Whitten and Wittingham's medium supplemented with 15% heat-inactivated human serum. Both histoenzymological reactions can be quantitated and have been evaluated by microdensitometric method. The results indicate that human spermatozoa depend almost entirely on anaerobic glycolysis during in vitro capacitation and suggest that both aerobic and anaerobic metabolism in spermatozoa are only slightly impaired by freezing-thawing and storage.