Biomedical subjects

Alessandro Zucchi

Publications and source records attributed to Alessandro Zucchi.

14 recordsLinked to original sources

PubMed2006

Must colposuspension be associated with sacropexy to prevent postoperative urinary incontinence?

OBJECTIVES: This prospective, randomised study investigated whether a prophylactic procedure, performed during colposacropexy for prolapse repair, prevents ex novo postoperative incontinence. Sixty-six consecutive continent patients with advanced prolapse were randomised into two groups: group A underwent sacropexy combined with a Burch colposuspension; no anti-incontinence procedure was performed in group B patients. METHODS: Work-up included clinical assessment (Halfway System and International Continence Society [ICS] classification for prolapse and Ingelman Sunderberg scale for incontinence), the Urogenital Distress Inventory and Impact Incontinence Quality of Life questionnaires, urogynaecologic ultrasound scans, and complete urodynamic testing that included the urethral pressure profile and Valsalva leak point pressure with reduced prolapse. Check-ups were done at 3, 6, 12 mo postoperatively and then yearly. Mean follow-up time was 39.5 mo. RESULTS: The mean age (+/- standard deviation) was 62+/-9 yr. All patients presented with grade (G) 3-4 prolapse. Postoperative incontinence was present in 12 of the 34 patients in group A: 7 G1; 4 G2, and 1 G3. Postoperative incontinence was present in 3 of the 32 patients in group B: 2 G1, 1 G3. The frequency of postoperative incontinence was significantly greater in patients who had undergone colposuspension (p<0.05). CONCLUSIONS: These preliminary data cast doubt on whether colposuspension should be performed during sacropexy for severe urogenital prolapse as prophylaxis for postoperative incontinence because it seems to emerge as overtreatment. Incontinence developed ex novo in 35% of continent patients treated with colposuspension combined with sacropexy.

Adult↗

PubMed2006

Varicocele and fertility: relationship between testicular volume and seminal parameters before and after treatment.

Varicocele is a condition of varicosity and tortuosity of the pampiniform plexus that is often associated with a reduction in the volume of the affected testicle. Today there is much debate about how much the varicocele actually damages the reproductive system and the mechanism through which this occurs. Furthermore, it has not yet clearly been established if treatment is truly useful to restore testicular function. The goal of this study was to evaluate changes in the volume of the affected testis after treatment and to examine any correlations between volume and seminal parameters. We evaluated 43 patients with left idiopathic varicocele with ultrasound scan of the testis before and after surgery; testicular volume was obtained using the ellipsoid formula. We also examined semen parameters before and at an average time of 1 year after the procedure, using the WHO indications. We performed 2 statistical analyses, comparing changes in testicular volume before and after surgery, and volume with seminal parameters. Statistical analysis shows a significant increase of testicular volume after varicocele treatment (P < .05). Furthermore, the total number of spermatozoa and fast progressive spermatozoa rates significantly increased after surgery (respectively P < .05 and P < .01) (Figure 1). The Spearman correlation coefficient shows a good relationship between testicular volume and total number of spermatozoa (r = .445; P = .01). Our data point to the possibility that the affected testicle could benefit in terms of trophism and function after varicocele treatment. Ultrasound scan at follow-up permits assessment of not only the presence of recurrence, but it is also useful for evaluating trophism.

Adolescent↗

PubMed2006

Cytosolic calcium levels in spermatozoa are modulated differently in healthy subjects and patients with varicocele.

OBJECTIVE: To study parameters connected to fertility in the semen of patients with varicocele. DESIGN: We examine the ability of spermatozoa obtained from patients with varicocele to respond with an increase of cytosolic Ca2+ ([Ca2+]i) to some stimuli that are connected with spermatozoa activation. SETTING: An academic research environment. PATIENT(S): Ten healthy volunteer donors and 10 patients affected by II or III grade left varicocele. INTERVENTION(S): Spermatozoa and prostasomes (vesicles of prostatic origin obtained from semen) were prepared according to standard procedures. Spermatozoa were stimulated with 1 microM P. The [Ca2+]i was evaluated with the FURA II method. MAIN OUTCOME MEASURE(S): The level of [Ca2+]i. RESULT(S): In resting cells, the level of [Ca2+]i was 120 +/-15 nmol/L (10 determinations). This value increases by > or =100 nmol/L upon stimulation with P. No difference was observed between spermatozoa obtained from healthy donors or from patients with varicocele. S-nitrosocysteine, a nitric oxide donor, and the fusion between spermatozoa and prostasomes increased the effect of P on [Ca2+]i in control spermatozoa but not in spermatozoa obtained from patients with varicocele. CONCLUSION(S): Different responsiveness of varicocele patients' spermatozoa to S-nitrosocysteine and/or to fusion with prostasomes may be among the possible causes of reduced fertility.

Adult↗

PubMed2006

Botulinum-A toxin injections into the detrusor muscle decrease nerve growth factor bladder tissue levels in patients with neurogenic detrusor overactivity.

PURPOSE: We investigated the effects of BTX-A on visceral afferent nerve transmission by measuring bladder tissue NGF levels in patients with neurogenic detrusor overactivity before and after intravesical treatment with BTX-A. We also compared the bladder tissue NGF content with clinical and urodynamic data. MATERIALS AND METHODS: A total of 23 patients underwent clinical evaluation and urodynamics with detection of the UDC threshold, maximum pressure and maximum cystometric capacity before, and at the 1 and 3-month followups. Endoscopic bladder wall biopsies were also obtained at the same time points. NGF levels were measured in tissue homogenate by enzyme-linked immunosorbent assay (Promega, Madison, Wisconsin). RESULTS: At 1 and 3 months mean catheterization and incontinent episodes were significantly decreased (p <0.05 and <0.001, respectively). On urodynamics we detected a significant increase in the UDC threshold and maximum cystometric capacity, and a significant decrease in UDC maximum pressure at the 1 and 3-month follow-ups compared to baseline (each p <0.001). At the same time points we detected a significant decrease in NGF bladder tissue content (each p <0.02). CONCLUSIONS: BTX-A intravesical treatment induces a state of NGF deprivation in bladder tissue that persists at least up to 3 months. As caused by BTX-A, the decrease in acetylcholine release at the presynaptic level may induce a decrease in detrusor contractility and in NGF production by the detrusor muscle. Alternatively BTX-A can decrease the bladder level of neurotransmitters that normally modulate NGF production and release.

Administration, Intravesical↗

PubMed2006

Treatment of urethral syndrome: a prospective randomized study with Nd:YAG laser.

INTRODUCTION: The urethral syndrome is characterized by irritative disturbances, the urgency-frequency syndrome and/or pain associated with negative urine cultures. Areas of metaplasic tissue in the trigonal-bladder neck region (trigonitis) are sometimes present. We performed a comparative randomized study to assess the efficacy of side- or end-firing neodymium (Nd):YAG laser surgery in destroying metaplasia and relieving symptoms. MATERIALS AND METHODS: Between January 1997 and December 2003, 62 consecutive women with the urethral syndrome and squamous metaplasia of the bladder neck-trigone, who were refractory to drugs, were randomly assigned to treatment with end-firing (group A) or side-firing (group B) Nd:YAG laser. Three, 6 and 12 months after surgery all patients underwent a clinical urological examination and cystoscopy. Surgery was considered successful when patients reported they were satisfied with the outcome or stated on the UDI-6 questionnaire that symptoms were reduced by at least 75%. RESULTS: Group A end-firing laser: patients rapidly improved (2-3 weeks) but symptoms worsened within 3 months. At 6-12 months, symptoms had improved in 19% of the 31 patients and remained unchanged or worsened in 81%. Group B side-firing laser: irritative disturbances worsened in the 7-10 days after therapy but markedly improved within 2-3 months. Symptoms significantly improved in 68% of the 28 patients and remained unchanged or worsened in 32%. Results were significantly better after side-firing laser (p < 0.001) and a trend towards improvements emerged as the joule levels rose. At 3 months, cystoscopy and biopsy showed squamous metaplasia was no longer present in patients whose symptoms had improved. Whitish areas were still present in the bladder neck-trigone in patients whose symptoms had remained unchanged or worsened. These patients were retreated. CONCLUSIONS: In the treatment of the urethral syndrome the few reports on attempts to restore a normal urothelium by means of diathermocoagulation and cryotherapy have been encouraging. Side-firing laser, which produces necrotic coagulation followed by reconstitution of normal functional epithelium, was significantly more successful than end-firing and was associated with a 78% success rate. These results are encouraging in patients who are usually refractory to medical therapy.

Adult↗

PubMed2005

Uterus preservation in surgical correction of urogenital prolapse.

OBJECTIVE: This study aimed to evaluate the efficacy of colposacropexy with uterine preservation as therapy for uterovaginal prolapse. Surgical techniques, efficacy and overall results are described. METHODS: In this prospective, controlled study, 34 of the 72 consecutive patients with symptomatic uterovaginal prolapse were treated with colposacropexy with uterus conservation (hysterocolposacropexy, HSP) and the other 38 with hysterectomy followed by sacropexy (CSP). Anchorage was achieved with two rectangular meshes in CSP and with one posterior rectangular and one anterior Y-shaped mesh in HSP. Check-ups were scheduled at 3, 6 and 12 months and then yearly. Pre-operative patient characteristics, operative and post-operative events and follow-up results were recorded. Mean follow-up was 51 months (range 12-115). RESULTS: No significant differences emerged in demographic and clinical characteristics between the HSP and CSP groups. Mean operating times, intra-operative blood loss and hospital stay were significantly less after HSP (p<0.001). At follow-up success rates were similar in the two groups in terms of uterine and upper vaginal support (100%). Recurrent low-grade cystoceles developed in 1/38 (2.6%) in the CSP group and in 5/34 (14.7%) in the HSP group (p=NS), recurrent low-grade rectocele developed in 6/38 (15.8%) and in 3/34 (8.8%) patients respectively (p=NS). No patient required surgery for recurrent vault or uterus prolapse. Urodynamic results showed that pressure/flow parameters improved significantly (p<0.001) in both groups. Thirty-one of the 34 patients (91%) in the HSP group and 33/38 (86.8%) in the CSP group were satisfied and would repeat surgery again. CONCLUSIONS: Colposacropexy provides a secure anchorage, restoring an anatomical vaginal axis and a good vaginal length. HSP can be safely offered to women who request uterine preservation. Whether the uterus was preserved or not, patients had similar results in terms of prolapse resolution, urodynamic outcomes, improvements in voiding and sexual dysfunctions. HSP has shorter operating times and less blood loss.

Aged↗

PubMed2004

Lichen sclerosus of the male genitalia and urethral stricture diseases.

INTRODUCTION: The true incidence of urethral involvement in patients with genital lichen sclerosus (LS) is unknown. We review the epidemiology and discuss the pathogenesis of LS and urethral stricture diseases. MATERIALS AND METHODS: During the period 1991-2002, of 925 patients who underwent urethroplasty for anterior urethral stricture, 130 patients (14%) received the diagnosis of LS. In all patients with LS the histology was re-examined to confirm the clinical diagnosis. Retrograde and voiding urethrography was used to establish urethral involvement in the disease. RESULTS: In 106 patients (82%) the histology provided the classical features of LS, and 24 patients (18%) showed some histological variations. In 49 patients (37%) the LS involved the pendolous urethra (meatus-navicularis-penile), and in 53 cases (41%) a panurethral stricture was evident. CONCLUSIONS: LS urethral involvement appears to be a much more common and extensive disease than previously reported, and requires particular care in its early diagnosis.

Adolescent↗

PubMed2004

Incidence and evolution of aortic aneurysm in patients with bladder cancer.

OBJECTIVE: The incidence of aortic aneurysm is increasing, due to age, hypertension, hyperlipemia and voluptuary abuse like smoking, the last one of the most important cause of bladder cancer. Our study analyzes the incidence of aortic aneurysm in a group of patients who underwent radical cystectomy for bladder cancer and its evolution during follow-up in relationship with surgical procedure and adjuvant therapy. MATERIALS AND METHOD: During pre-operative staging of 173 patients, all affected by bladder cancer and then treated with radical cystectomy, we studied aorta and iliac artery diameters, as a part of our ultrasound scan evaluation. All patients underwent post-operative measurement of normal and abnormal aorta and common iliac artery during follow-up. RESULTS: At the pre-operative staging 19 patients (10.9%) had aneurysms in the aortic-iliac axis (A.A.). During follow-up in 5 patients the A.A. did not develop, whereas in 14 cases it increased within 12 months after surgery and then with an increase <0.5 mm per year, with no relationship with type of surgical procedure, urinary diversion, adjuvant therapy. No cases required a vascular surgical approach during the follow-up. Only 1 patient of basal 154 normal ones developed an aneurysm of the common right iliac artery, treated with endoprosthesis. CONCLUSIONS: The natural development or risk of aneurysm rupture in patients with bladder cancer depends on its dimensions but also on radical surgery, urinary diversion or adjuvant therapies. In our experience all these factors seem not to influence aneurysms if present nor determine de-novo development.

Adult↗

PubMed2004

Renal papillary adenocarcinoma with unusual metastases: case report and review of the literature.

OBJECTIVE: This study focuses on a case report on a patient with renal carcinoma who developed metastases at unusual sites. We also reviewed the literature, including the theories proposed by various authors on the possible etiology of these odd localizations. CASE REPORT: A 48-year-old patient underwent conservative surgery for renal carcinoma (papillary adenocarcinoma). Twenty-two months later, he developed mediastinal metastases and underwent immunotherapy; two years after that he had metastases to unusual sites such as the urethra and the prostate. The mechanisms responsible for metastases to these unusual sites are not entirely clear yet. We feel it is important to note the highly aggressive and multifocal nature of papillary adenocarcinoma, and the need to perform closer follow-up on these patients, particularly if nephron-sparing surgery has been performed.

Adenocarcinoma, Papillary↗

PubMed2004

Clinical staging accuracy of renal tumors.

OBJECTIVE: To evaluate the reliability of measurements obtained using standard imaging techniques (ultrasound and CT scan) vs pathological measurements and the relationship between clinical staging and the choice of the type of surgery. We also analyzed the relationship between cancer parameters (size, site, type of surgery) and prognosis. MATERIALS AND METHODS: A retrospective analysis was conducted to examine a series of 140 patients with kidney cancer, all of whom underwent preoperative staging with abdominal ultrasound scan US and CT scan. To assess agreement between US and CT measurements and the pathologic size of renal tumors, we calculated the mean difference between the techniques, Pearson's correlation coefficient and Bland-Altman test. RESULTS: The comparison between imaging and pathological findings revealed a good classification of tumor dimensions between the two imaging methods and pathologic size (correlation coefficients all over 0.8), and with limits of agreement of +/- 2.2 cm for US measurement and of +/- 2.3 cm for CT measure. We observed that the range in which the measurement error is lowest is over 6 cm: in other words, when smaller lesions are present there is a greater likelihood of committing measurement errors. As expected, logistic regression analysis shows that the size of the tumors significantly influenced the surgical approach and survival at five years follow-up. CONCLUSIONS: The imaging methods used in clinical staging of renal tumors currently allow us to select the most appropriate surgical option with a certain amount of confidence. Tumor size continues to be one of the most important factors in prognosis and it can influence both the surgical approach and cancer-specific survival.

Adolescent↗

PubMed2003

Color Doppler ultrasonography in the diagnosis of vascular abnormalities associated with ureteropelvic junction obstruction.

PURPOSE: To determine if color Doppler ultrasonography is able to identify vascular abnormalities linked to ureteropelvic junction (UPJ) obstruction. PATIENTS AND METHODS: We used color Doppler scanning in 21 patients to determine whether there were aberrant vessels. RESULTS: The study detected 11 aberrant vessels, resulting in 10 true positives and 9 true negatives. Thus, the overall diagnostic accuracy was 90.4%. CONCLUSION: Color Doppler ultrasonography is reliable in the preoperative diagnosis of aberrant vessels associated with UPJ obstruction.

Adolescent↗

PubMed2002

[Staging of prostatic carcinoma: TRUS prospective study versus endocoil MRI].

OBJECTIVE: Accurate staging of prostatic cancer is important for planning an optimal treatment, such as radical prostatectomy in clinical stage T2. About 40-50% of patients operated for cT2 disease show a pathological stage T3 disease. In a prospective study we analysed accuracy of TRUS and endocoil MRI in a group of patients before radical prostatectomy. MATERIALS AND METHODS: 33 consecutive patients suspicious of prostate neoplasms were studied and staged with TRUS and endocoil MRI before prostatic biopsy and before radical prostatectomy. One urologist trained in TRUS conducted the exam, while one radiologist interpreted the MRI studies in a blind mode. The criteria evaluated were accuracy of global staging, extracapsular extension (ECE) and seminal vesicle invasion (SVI). These results were correlated with the histopathological findings after radical prostatectomy. RESULTS: The histopathological results showed 14 patients (42%) with pT2 disease, 18 patients (54%) with pT3 disease and 1 case (4%) of pT4 disease. TRUS showed a low sensitivity (38%) and a good specificity (78%), with an overall accuracy of 50%; the best result was 96% specificity for SVI. Endocoil MRI showed a good sensitivity (70%) and specificity (76%), with an overall accuracy of 73%. Endocoilc was also useful to stage T1c disease when TRUS is negative. TRUS tends to understage, whereas endocoil MRI over-stages prostate cancer. CONCLUSIONS: TRUS and endocoil MRI may help in decision making about the appropriate treatment of prostatic cancer, even if they have limited current value, due to understaging or overstaging.

Aged↗

PubMedDate not supplied

Overexpression of glyoxalase system enzymes in human kidney tumor.

PURPOSE: The purpose of this study was to investigate the messenger RNA expression and activity of glyoxalase I and glyoxalase II enzymes in a human renal carcinoma (clear cell adenocarcinoma) and in pair-matched normal tissue. PATIENTS AND METHODS: Tumor and nontumor pair-matched specimens from the same organ were collected during radical nephrectomy from a group of 12 patients of both sexes. The mean age of the patients was 52.3 years (range, 50-60 years), and none of them had previously undergone neoadjuvant therapy. Gene expression and activity were measured by ribonuclease protection assay and current spectrophotometric methods, respectively. Intracellular levels of methylglyoxal were detected by high performance liquid chromatography. RESULTS: A significant increase in the transcription levels of both glyoxalase I (about ninefold) and glyoxalase II (about threefold) was observed, compared with the pair-matched noncancerous tissues. Glyoxalase I activity was also higher in the pathological samples (about 2.5-fold) compared with the control samples and correlated with a significant decrease (about twofold) in methylglyoxal concentrations. At variance, glyoxalase II activity was significantly lower in pathological tissues than in the normal ones. DISCUSSION: Our findings suggest a possible role of the glyoxalase system enzymes in the chemoresistance displayed by the kidney tumor. In fact, such a refractory behavior involves a decrease in the methylglyoxal level, a potent apoptosis activator. In addition, glyoxalase II activity decrease in the adenocarcinoma tissue suggests a likely role of the intermediate S-D-lactoylglutathione by supplying energy in actively proliferating cells. Finally, we point out a possible use of glyoxalase I inhibitors as anticancer drugs.

Adenocarcinoma, Clear Cell↗

PubMedDate not supplied

Treatment of varicocele: randomized prospective study on open surgery versus Tauber antegrade sclerotherapy.

The goal of this randomized prospective study in patients with varicocele was to evaluate the outcome following open surgery with inguinal approach versus antegrade sclerotherapy according to the Tauber procedure. From January 2002 to November 2003, we recruited 64 patients with left varicocele for this study. All patients were clinically examined, before surgery and again 8 months postsurgery, by objective examination, scrotal color Doppler ultrasound, and semen analysis. These patients were randomized in a balanced 4-block pattern: depending on randomization, the patients underwent open surgery (group A: 32 patients) or antegrade sclerotherapy according to the Tauber procedure (group B: 32 patients). At the current follow-up, it is possible to evaluate all the patients for whom we have preoperative and postoperative Doppler imaging and semen analysis. An analysis of seminal parameters shows a statistically significant improvement of the rate of fast progressive spermatozoa (P < .05) and reduction in immotile spermatozoa (P < .01) in those patients who underwent sclerotherapy compared to the patients who underwent open surgery. The outcomes of all other parameters (number and morphology) are fully comparable. Operating time is decidedly shorter for antegrade sclerotherapy (P < .01), but there are no significant differences in terms of early or late postoperative complications. It is widely known that varicocele is a condition found in 9% to 23% of the male population around the world; this percentage rises to 40% among infertile males. The treatment of this condition not only resolves clinical symptoms but also stops continuous damage to spermatogenesis, thereby potentially improving fertility. Our experience demonstrates that sclerotherapy (Tauber procedure) combines shorter surgical time and faster recovery of normal daily activities with significant improvement in sperm motility.

Adolescent↗