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 evaluated the usefulness of percutaneous nephrostomy in 1700 patients treated for reno-ureteral stones by extracorporeal shock wave lithotripsy (SWL). Out of this group 81 patients (5.8%) underwent echo-guided percutaneous nephrostomy (EPCN): the procedure has been performed in local anesthesia in 38% of the cases (31 pts) before SWL and in 62% (50 pts) after. The majority of EPCN were carried out for the presence of acute or chronic ureteral obstruction with echographic evaluable dilation of pyelocaliceal system when retrograde ureteral manipulations failed or were considered unsuitable. EPCN before SWL was performed because of ureteral stone and uncomplicated pyelocalyceal dilation (19 pts); ureteral stone, pyelocaliceal dilation and fever > 38 degrees C (3 pts); ureteral stone, pyelocalyceal dilation and functional IVP exclusion (5 pts); pyelic stone in solitary kidney (1 pts); ureteral stones in pregnancy (2 pts). EPCN after SWL was performed because of uncomplicated, persistent pile-up (31 pts); ureteral pile-up complicated by fever and colics (9 pts); ureteral obstructing fragments (2 pts); double J obstruction by stone dust (3 pts); persistent ureteral pile-up around double J (3 pts); anuria in solitary kidney (1 pt). Out of the patients who underwent EPCN before SWL 13% were stone free and without drainage at discharge, 77% had passable stone fragments at discharge and drainage has been taken out at 15-30 days check up, 10% had unbroken stone and underwent with drainage to ureterolithotripsy.(ABSTRACT TRUNCATED AT 250 WORDS)

The diagnostic contribution of the radiological techniques (intravenous urography, angiography, sonography, computer tomography) is well-known. On the contrary, in this field, the possibilities of the Nuclear Medicine are underestimated. Radiological methods have high detail recognition but are only suitable for assessing the functional significance of morphological changes in a restricted sense; in the last 25 years, nuclear medical renal diagnosis has achieved a differentiated development stage which permits new qualitative and quantitative tests. The radioisotopic methods offer morphological informations which surely are less exact than those given by radiological techniques, on the other hand they add irreplaceable parameters of functional significance; these parameters concern the perfusion and the accumulation and excretion constants of selected areas of interest in renal districts. This is made possible by a wide choice of radiopharmaceuticals, having a different dynamic pattern and biodistribution. The Authors consider scintigraphic imaging of different renal pathologies: trauma, characterized by hypoperfusion; hematoma and/or urinoma; pseudotumor and carcinoma. Nuclear medical techniques allow in nearly all the cases a rapid and exact diagnostic guidance. The AA. emphasize the absence of invasiveness, the simplicity and the good compliance of these methods in all patients, even if seriously ill, and the usefulness in follow-up and diagnosis of several pathological conditions. Finally, they underline the absence of an appreciable radiobiological hazard.

This paper is reporting the experience of the Authors in the use of Duplex-scanner and eco-color-doppler in the diagnosis of the erectile dysfunctions and particularly in the importance of vascular (arterious and venous) origin. For this purpose, we selected a sample constituted of 41 patients: 22 with psychogenic, 8 with arterial, 5 with venous impotence, 5 patients with Peyronie's disease and 1 patient with posttraumatic arterio-venous fistula. The Authors, while underlining the remarkable accuracy and diagnostic reliability of eco-doppler, emphasize the indication of the method up to consider it "investigation of prime choice", not only in the patients with the dysfunction of vis erigendi but, in the cases in which a morphological evaluation, besides hemodynamical one, become necessary.

If we define erectile impotence as the inability to achieve and maintain a firm erection we can distinguish several pathogens of impotence: psychologic disorders, neurogenic sinusoidal disorders, arterial disorders, venous & sinusoidal disorders and systemic diseases and other disorders can cause erectile impotence. An etiologic screening of impotence must be carried out by Urologists in order to adopt the best surgical approach. Especially when surgery has to be planned, a complete, often invasive screening associated with a super-specialist diagnostic study is necessary at the beginning of any procedure. Different approaches to impotence can be adopted on the basis of patient's age, etiology and failure of other devices. The main methods of surgical correction of impotence may be divided as follows: a) percutaneous transluminal angioplasty (P.T.A.); b) revascularization; c) surgical treatment of "venous leakage", d) trans-luminal veno-occlusion (T.L.V.O.); e) correction of penile curvature; f) prostheses placement. The diagnosis of arteriogenic impotence depends upon the arteriographic demonstration of bilateral hemodynamically significant obstruction. In our experience the injection of papaverine during the test has provided a better visualization of cavernous arteries and helicine branches. Reduction of luminal diameter by more than 50% suggest a hemodynamically significant stenosis. Intracavernous injection of vasoactive agents has provided an attractive alternative to surgery. We have employed papaverine alone or with phentolamine or phenoxybenzamine. After short term treatment, some patients have achieved good erections without further injections. For P.T.A. of the distal internal pudendal arteries our approach has been via the ipsilateral or contralateral femoral arteries. Under local anesthesia a penile arteriographic catheter is placed in the internal pudendal artery.(ABSTRACT TRUNCATED AT 250 WORDS)

The presence of penile nodule, curvature, disorders in blood flow to and from the corpora cavernosa is often correlated with organic sexual impotence. Echography allows to obtain a clear imaging of penile structures: diameters of corpora cavernosa can be measured before and after injection of vasoactive drugs. In our study penile structure were evaluated using a Combison 310 and a Toshiba with 7.5 MHz probe. In a lot of cases echography was repeated after intracavernous injection of PGE 1 or papaverine. The equipment needed for this evaluation is expensive but echography is undoubtedly less invasive than other equivalent examinations like cavernosography. Although the sensitivity and specificity of penile echography have not yet been clearly established this test is generally considered to be an useful and objective one. Penile echography is particularly usefull in discriminating between echogenic and not-echogenic nodules in case of Peyronie disease.

The authors underline the diagnostic accuracy of transurethral bladder ultrasonography in the estimation of local infiltration of bladder tumors. The study was conducted on 21 patients who underwent either endoscopic resection or cystectomy. The clinical staging obtained by transurethral echography was compared with the pathological one. The results obtained by either method were comparable in all cases.

Despite the genitourinary system is prone to infections by the Human Virus of Immunodeficiency, so far poor interest has been focused on urological manifestations of AIDS. We thoroughly reviewed the Literature and examined the different patterns of HIV infections on the kidneys, the prostate and the testes. An extensive description is given.

B.L. a 27 year old bilaterally cryptorchid patient underwent right testicular autotransplantation in the presence of a quite normal testis. After one year the patency of microsurgical anastomosis was confirmed by means Doppler flowmetry and scrotal echography demonstrated the presence into the scrotum of a testis provided of a normal echogenicity. Left laparoscopic orchiectomy was planned. A small semilunar skin incision was made just below the rime of the umbilicus. Veress needle was introduced: as soon as the needle pierced the parietal peritoneum, its spring mechanism was released allowing the sharp needle point to retract leaving only the blunt tip protruding. Carbon dioxide gas was insufflated through the side part of the Veress needle until adequate abdominal distension was achieved. After having removed the Veress needle, the laparoscope on its sharp-pointed trocar was introduced into the peritoneal cavity and left testis was easily localized. Four trocars were introduced up to proceed to laparoscopic orchiectomy. The patient was discharged two days after. In our opinion in the presence of a bilateral cryptorchism in the adult, is better to plan a monolateral autotransplantation. After having verified the long-term result of microsurgery we can decide if a contralateral orchiectomy has to be planned.

The authors briefly illustrate some biological and epidemiologic characteristics of the malignant urologic tumors; then they describe the modalities of metastasizing underlining that this process is determined not only by hematic and lymphatic dissemination but also by sequential and complex events "metastatic fall", involving multiple guest-tumor intersections to the organotropism of the neoplastic cells and to their intrinsic aggressiveness and to the histological type of tumor. Afterwards the authors analytically analyze the most important malignant neoplasms of the urogenital apparatus either as clinical importance or as statistic incidence.

Hepatic metastases from genito-urinary tract neoplasms are infrequently eligible for surgical treatment. Nevertheless, some patients affected by primary renal adenocarcinoma or by Wilms' tumor, with single or lobe-confined hepatic metastasis, can be enrolled for a surgical excision of the hepatic lesion. Selection criteria of the patients are fully discussed; surgical treatment by anatomical resections (segmentectomy or hepatectomy) with primary parenchymal dissection are preferred.