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E Austoni

Publications and source records attributed to E Austoni.

At least 19 recordsLinked to original sources
PubMed1998

[Varicocele and its repercussion on infertility. Indications and limitations of surgical intervention].

According to different Authors, varicocele incidence in unselected population fluctuates from 8 to 22% but in selected population affected by sterility incidence ranges from 21 to 39%. However other Authors have demonstrated that about 50% of patients suffering from varicocele have semen alterations. Various mechanisms have been suggested for testicular dysfunction associated with varicocele: intrascrotal hyperthermia, reflux of renal and adrenal metabolites from the renal vein and hypoxia. The most important semen alterations are observed in patients suffering from grade 2 and 3 varicocele and especially these patients must undergo surgical operation. According to recent findings, better results about the improvement of semen quality are obtained by operating children in puberal age. This clinical approach allows a prevention of testicular hypotrophy or, when this is already present, its reversibility. Varicocele surgical treatment makes use of traditional techniques microsurgical or not and mininvasive techniques. After renouncing of intrascrotal varicocelectomy, traditional techniques provide ligature and section of ectasic spermatic veins, after a surgical high (at level of the internal inguinal ring) or low (over inguinal canal) skin incision. Microsurgery allows recognition and protection of lymphatic and arterial vessels and execution of microsurgical anastomosis between venous spermatic and ileo-femoral circle vessels, when this is necessary. Internal spermatic vessels and vas deferens can be visualized through the laparoscope and so laparoscopic varicocele treatment was suggested. These new techniques and traditional operation are burdened with the same percentage of relapses but in laparoscopic procedure complications are more important. Recently radiographic occlusion techniques are also utilized (internal spermatic vein retrograde scleroembolization); the percentage of relapses is between 4 and 11%, with no risk of postvaricocelectomy hydrocele but with risk of loss of kidney (migration of the ballon or coil into the renal vein). Surgical treatment of varicocele produces a significant improvement in semen analysis in 60 to 80 per cent of patients affected by testicular dysfunction. Pregnancy rates after varicocelectomy are including from 20 to 60 per cent with most series averaging about 35 per cent.

Adolescent↗
PubMed1998

[Andrologic surgery].

The need of an economic and social low costs drive more and more surgeons towards the day surgery. The always growing diffusion of local anesthetic supports this trend. The drugs used as local anaesthetics are: carbocaine, procaine, lidocaine and bipivacaine. The Day Surgery can be largely employed in the therapy of andrological pathologies. In fact the anatomical placement of male genital apparatus allows easy possibilities of anaesthetical and surgical approach. It is so possible perform the following operations: meatotomy, section and plasty of fraenum, extirpation of Papovavirus lesions, circumcision, paraphymosis setting, corpora cavernosa drainage in priapism, section and ligation of deep dorsal vein, corporopexi, glandulopexi, cavernous crural plication, endocavernous penile prosthesis' implant, congenital or acquired penile recurvatum correction, blandulectomy, hepidydimis' cyst excision, testicle's biopsy, subcapsular orchiectomy sec. Higgins, testicular prosthesis' implant, resection and eversion of vaginal tunic of testicle in hydrocele's therapy, vasotomy and section and ligation of internal spermatic vein in varicocele's surgery. The Authors describe the anaesthetical and surgical techniques for bring forward these operations in Day Surgery.

Adult↗
PubMed1996

[New trends in the surgical treatment of penile carcinoma].

With the current oncological emphasis on radical treatment allied to minimal invasiveness, choice of treatment relies on precise clinical staging. The corpora cavernosa of the penis represent a well defined anatomical structure distinct from the corpus spongiosum and the glans which are tightly connected to one another. In case of primary penile tumour the T.N.M. classification of the American Joint Committee on Cancer includes in the T2 stage both infiltration of the corpus spongiosum and of corpora cavernosa. Jackson's classification seems to be more pertinent as it limits to stage 1 cases involving the glans and corona and classifies as stage 2 cases limited to the corpora cavernosa. Partial penectomy can prove overly invasive, yet insufficiently radical, if the anatomical continuity of the spongious tissue is not considered. Carcinoma of the glandular corpus spongiosum without cavernosal involvement indicates glandulectomy with partial uretrectomy and apical cavernous-urethrostomy. Preserving the corpora cavernosa is an option of great relevance to the quality of life of the patient: erectile ability and stand-up micturition are not affected and the patient keeps complete sexual ability and orgasmic sensation. In case of scrotal or public involvement, emasculation with hemipelvectomy must be attempted; if indicated, it can be followed by radiotherapy. Perineo/abdominal reconstruction can be followed by urinary diversion with adjuvant chemotherapy. In selective cases neophallic reconstruction can be later attempted using the inferior abdominal rectum muscle.

Adult↗
PubMed1996

[Radical surgical treatment of Peironie disease by excision of the plaque and dermal graft allowing conservation of erection].

The surgical treatment of the La Peyronie disease is the complet excision of the fibrom plaque followed by dermal skin grafts. This technique is applied for stabilised cases in which coït has become uneasy due to the deformation of the penis. A complete isolation of the vasculonervous dorsal pedicle guaranties a good erection. In 15 years this technique was applied in 400 cases followed during 2 years. In 7% of cases a recidive of the incurvation occurs. In 20% the erection was unsatisfactory.

Adult↗
PubMed1996

[Surgical therapy of obstructive azoospermia: microsurgery].

Microscopic procedures for therapy of obstructive azoospermia or of vasectomy reversals have resulted in accurate reapproximation of ductal structures. The success of vasovasostomy appears to be influenced by the length of time that has passed since the vasectomy was performed or the obstruction become. Failures of vasovasostomy may be attributed to anastomotic stenosis, sperm antibodies, epididymal dysfunction, or an unrecognized epididymal tubule blowout with subsequent obstruction. The latter condition should by suspected when, at the time of the initial vasovasostomy, there is lack of fluid containing spermatozoa in the cut end of the testicular portion of the vas. Chronic intratubular pressure may cause an epididymal blowout, with subsequent spermatic granuloma and obstruction in the epididymal tubule, that may also be related to a congenital disorder or a postinflammatory condition. Spermatozoa gain maturation and the capacity for motility as they move from the caput to the cauda of the epididymis as possible. Microsurgery allows direct microtubular anastomosis between the epididymal tubule and the cut end of the vas. Some conditions are not amenable to conventional surgical techniques, such obstructed azoospermia due to congenital bilateral absence of the vas deferens or to severe damage to the reproductive ducts. To treat these patients surgeons have devised reservoirs (artificial spermatoceles) to collect spermatozoa to be used for artificial insemination. An alternative treatment method for obstructed azoospermia is to obtain sperm from the epididymis with the use of an operating microscope. Although sperm have been obtained the poor sperm motility requires either in vitro fertilization or GIFT. The technique looks promising, although improved techniques to enhance the motility of the collected sperm will ultimately yield better results.

Epididymis↗
PubMed1995

Andrological laparoscopy.

The laparoscopic technique has well defined indications for some andrological procedures such as the diagnosis and the treatment of cryptorchidism, but its role remains controversial in varix ligation for which laparoscopy is however the newest development. At the Institute of Urology of the University of Milan from January 1992 to June 1994 five adults patients with undescended and unpalpable testis underwent laparoscopy. In 4 cases laparoscopic orchiopexy (2 direct and 2 staged procedures) and in one case laparoscopic orchiectomy have been performed. In the same period 20 cases of varicocele (6 bilateral) have been observed and treated by laparoscopic varix ligation. For cryptorchidism after the identification of the testis we decide on the basis of parenchimal trophism wheter to perform orchidopexy or orchiectomy. A single step laparoscopic orchiopexy can be performed if the undescended testis is located proximal to the internal inguinal ring and if the mobilization of the spermatic vessels allows it. A Fowler-Stephens staged orchiopexy is indicated for intra abdominal testicle with short spermatic vessels. In the first stage the spermatic vessels are isolated and divided relying on the compensation offered by the deferential and extrafunicular vessels. After six months, once the testis trophism has been ascertained, the testis can be placed in the scrotum. For varicocelectomy the peritoneum is incised at the projection of the spermatic cord from the internal inguinal ring. A blunt and gentle dissection prepares the spermatic vascular bundle, the spermatic artery is identified and isolated and the vein are clipped and divided.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Radical perineal and retropubic prostatectomy: comparison of technics].

Today we may consider radical perineal prostatectomy as an example of mild invasive surgery compared with the retropubic. Technique is found less traumatic account of the precision of the approach, the accuracy of hemostasis and urethral bladder suture and the speed of postoperative handling. The only disadvantage related with the impossibility of transperineal pathological lymph node staging can today be satisfactory overcome after the advent of laparoscopic lymph node methods which permits safe non invasive preoperative hystological examination. The authors show the technique of laparoscopic and surgical therapy, concluding that perineal prostatectomy is a better approach toward retropubic radical prostatectomy, if combined with preoperative laparoscopic pelvic lymphadenectomy.

Humans↗
PubMed1995

[Revascularization: light and shadow].

Advances in the knowledge of penile haemodynamics make evidence of two fundamental mechanisms in the physiology of erection: 1) arterial vasodilatation; 2) blockage of venous outflow. Therefore peripheric vasculogenic erectile impotence presents two pathogenetic possibilities: 1) from insufficient arterial flow; 2) from increased venous outflow. It is therefore very important to make the correct diagnosis of the patient with erectile disturbances in order to determine an appropriate therapy. The following examinations are routine tests carried out at our Institution: NPT test, basal and dynamic Doppler-sonography, OOE-OME (evaluation of output obtaining and maintenance erection), basic and dynamic cavernosography, digital angiography, dynamic NMR. After an accurate diagnostic assessment medical treatment can begin, based essentially on the cavernous infusion of vasoactive drugs, in light forms; surgery is resorted to severe cases, or in cases of failure of medical therapy. Proposed operations may be divided into 3 groups: 1) arterio-cavernous by-pass; 2) arterio-arterial by-pass; 3) venous surgery. Since 1978 the successive experiences of the Authors in this field and the better knowledge of penile vascular structures have led to a standardization of the methods used, with partly original techniques (epigastro-dorsal antiflow and orthoflow double by-pass), which, with selective application, have raised the percentage of pulsing anastomoses at 18 months of 82%.

Follow-Up Studies↗
PubMed1995

[Radical surgery and conservation of erection in Peyronie's disease].

The radical surgical option we propose for Peyronie's disease consists in removing the sclero-hyanolitic focus (plaque) and replacing it by an autologous dermal graft taken from the upper outer thigh area. Between 1981 and 1994, we operated 564 patients with Induration penis plastica (IPP), 418 of whom underwent plaque excision and dermal grafting. All could be assessed at two-year follow-up. Two main complications were observed: penile flexure relapse (71 Pts, 17% of cases), and erectile dysfunction with decreased corporal rigidity (84 Pts, 20% of cases). A mild deviation of the penis can occur some months after surgery and it is not due to disease progression (as it should have evolutive characteristics) but is mere scar retraction (44 Pts, 76% of examined relapsed flexures). The degree of this graft retraction is linked to the individual's histologic response and can be due to an idioptic tissular response or to an insufficient size of the patch. In some cases, the post-op penile flexure can result from a progression of disease (14 Pts, 24% of examined relapses flexures) and can be due either to a new "focus" or to an incomplete removal of the previous plaque. As the patient will date the onset of a possible postoperative erectile deficit from the time of the operation, it is advisable to assess preoperatively the real erectile ability of all patients. Furthermore, a post-op impaired erectile response (84 Pts, 20%) could result from a subalbuginear fibrosis of the erectile tissue that leads to a caverno-occlusive dysfunction (60%). In more than 35% of patients we found a psychogenic component, due to post-surgical stress, that involves an adrenergic hypertone with peripherical vasoconstriction. In few cases (4%) the post-op erectile dysfunction is the consequence of peroperative arterial damages that results in hypoaesthesia of the glans (injury of dorsal arteries) or in failure to obtaining corporal rigidity (damage of cavernosal arteries). A review of our experience involving plaque excision and dermal grafting led us to propose this option in case of mechanical disturbance during coitus and when the association of erectile dysfunction can be excluded.

Follow-Up Studies↗
PubMed1994

[Validity of superficial echography in the study of urethral pathology].

In male patients routine examination for urethral disease includes retrograde and anterograde urethrography and urethroscopy. In the patients underwent radical cystectomy, detection of cancerous cells in the urethral washing suggest cancer relapse. Nowadays we can achieve a sonographic study of the anterior male urethra, using a superficial high frequency ultrasound probe. Since September 1992 till July 1993, 12 patients underwent cystectomy at our Institution and 13 patients affected by urethral stricture, have been investigated by routine examination and sonographic urethrogram. In the first group of patients, out of 3 patients with urethral tumor, sonourethrography has confirmed the presence of tumor in 2 cases. In these second group of patients, sonourethrography has located the stricture, evaluated the length, calculated the diameter of the stricture and the depth of fibrosis. Sonourethrography is a non-invasive method that can provide valuable information about the urethral lumen and the urethral wall.

Aged↗
PubMed1994

[Dynamic renal echography versus urography in the follow-up of patients who have undergone ureterosigmoidostomy].

The main post uretero-sigmoidostomy complications are stricture of the anastomosis, chronic infection and urolithiasis. In our institution the patients with ureterosigmodostomy undergo a follow-up protocol in which blood chemistry, ultrasonography, intravenous pyelography and C.T. are periodically performed. The aim of the present paper is to compare the accuracy of kidney sonography after diuretic stimulation with intravenous pyelography in the diagnosis of ureteral stenosis. Out of 91 patient with ureterosigmoidostomy 18 patients (34 kidneys) underwent intravenous pyelography, a basal U.S. and then a dynamic one at 5, 10, 15, 30, 45, 60, 90, 120 minutes after administration of furosemide 20 mg i.v. At basal U.S. 27 kidneys were normal and 7 showed a dilations. After diuretic stimulation we observed 16 normal kidneys, 16 dilated units and 2 intermittent hydronephrosis. Out of 16 dilated kidneys 6 became normal in 60 minutes. Out of 10 dilated units 3 were normal in 90 minutes (hipotonic), 2 were normal before 120 minutes (low grade obstruction) and 5 were dilated after 120 minutes (high grade obstruction). With intravenous pyelography we observed 27 normal kidneys and seven dilated units. Dynamic sonography have shown high sensibility (100%), specificity (88.8%) and accuracy (91%) in diagnosis of ureteral obstruction in to I.V.P. in the follow-up of this kind of divesion.

Colon, Sigmoid↗
PubMed1994

[Island flap in the surgical treatment of hypospadias].

Surgery of hypospadias represents an interesting field of innovatory ideas. Many methods may be suitable and many modifications can be performed. There is no one method for all kinds of hypospadias. It is necessary to find the right method for each patient. The result often depends upon the experience of the surgeon with a particular method. The choice between straightening and urethroplasty in one or two stages depends on cost-benefit ratio and evolution at distance of the straightening must be taken into account as well tissue consumption imposed by the urethroplasty, with one stage straightening that makes reintervention very difficult. In the latter case, a multi-stage operation will be necessary with flaps for urethroplasty after the straightening, or, in a more developed penis, a shortening operation according to Nesbit. With two-stage method, in case of relapsed curvature, this can easily be treated, if tissue is available. For a good result of urethroplasty the ability of surgeon, a constant calibration of the canal, plenty of elastic tissue for the neo-urethra, care not to suture on these planes, are highly important. In our opinion Duplay's method observes these requisites. Two-stages surgery allows easy correction of any eventual relapsing incurvature, with no problems for the following urethroplasty. One-stage surgery allows the problems to be resolved in a single surgical Step, but involves the risk of tissue consumption and proximal stricture.

Follow-Up Studies↗
PubMed1994

[NPT: nocturnal penile tumescence test].

The recording of the variations of penile tumescence and rigidity during nocturnal unconscious erections that usually occur with the REM phases of sleep, has been considered the diagnostic tool of choice in the workup of erectile disturbances for a number of years. Such a success is partly due to its absence of invasiveness. Moreover this test was believed to allow to differentiate between the psychogenic and organic origin of impotence. As some authors have recently reported, anxiety state (common among patients who undergo invasive andrological procedure in the office) can at times influence the content of the dream state, thus negatively affecting the spontaneous nocturnal erections. Besides, sleep disturbances such as apnea and motor agitation can also induce erroneous interpretations of NPT graphs. Further, dysfunctions at the level of the cortex and the spine still allow the occurrence of nocturnal tumescence but determine an erectile deficit in the awake state. Clinically, all this poses new questions about the effectiveness of the NPT test in the study of the origin of impotence. The diagnostic methods, despite its world-wide diffusion, remains, under certain aspects, obscure: the operative details and, above all, its interpretative criteria. All this impedes the achievement of uniformity in the evaluation of the results obtained thanks to this test (e.g. the number and duration of erectile episodes, the interpretation of tumescence on its own, of the basal-apical dissociation, of the erectile episodes occurring immediately before waking, and of those of short duration).

Aged↗
PubMed1994

[The cavernosometry].

The recent clinical and experimental research innovations in Andrology make possible the following classification of impotence: "Failure to initiate" "Failure to store" "Failure to fill" The last aspect, including veno-occlusive dysfunction, is continuously reevaluated by andrologic studies. The main diagnostic procedure of this complex problem, in constant evolution, is represented by cavernometry. Recently, but with full success, we are utilizing direct radioisotopic penogram in video sexy stimulation: in preselection function but probably in future with substitutive function of the more invasive and traditional cavernometry. In spite of this methodologic progress the findings of cavernometry are in continuous discussion as in tumultuous evolution, in anatomo-physiological environment, is the intracavernous district that, for many aspects, necessity of ulterior histochemical, pharmacodynamic and neurophysiological acknowledgements.

Diagnosis, Differential↗
PubMed1994

Modified corporopexy as a new approach to the treatment of congenital rotation of the penis.

Congenital anomalies of the penis expressed in various forms of flexures can be associated with a rotation of the shaft. An asymmetrical insertion of the suspensory ligament on the dorsal surface of the tunica albuginea often accounts for corporal rotation. This distorts the spatial relationship between the corpora cavernosa and the pubic bone. The two corpora may overlap and the shaft is partially rotated. For the surgical treatment of these defects we proposed (1989) a technique of contrarotation of the tunica albuginea which was later abandoned because it was too invasive. We developed a technique based on the ipsilateral re-suspension of the suspensory ligament of the penis between the tunica of the lower corpus and the pubic symphysis to restore the true axis. The neurovascular adnexa, the corpora cavernosa, and the corpus spongiosum remain untouched.

Adolescent↗
PubMed1994

[Erectile complications after radical surgery for penile plastic induration].

The radical surgical option we propose for Peyronie's disease consists in removing the sclero-hyalinotic focus of disease and replacing it by an autologous dermal graft taken from the upper outer thigh area. Between 1981 and 1991, we operated 335 patients with IPP, 152 of whom underwent plaque excision and dermal graft. All could be assessed at two-year follow-up. Two main complications were observed: mild penile flexure due to scar retraction of the graft (35% of cases), and partial erectile deficit with decreased corporal rigidity (17% of cases). The degree of the graft retraction is linked to the individual's histologic response. A mild deviation of the penis can occur some months after surgery and is not a relapse flexure due to disease progression (as it should have evolutive characteristics) but is mere scar retraction and will spontaneously regress. As the patient will date the onset of a postoperative erectile deficit from the time of the operation, it is advisable to assess preoperatively the erectile ability of all patients. Furthermore, an impaired erectile response could result from hypoaesthesia of the glans, post-surgical stress, and fibrosis of the erectile tissue. A retrospective assessment of radical surgery cases involving plaque excision and dermal graft lead us to propose this option where precise indications apply, providing the presence of other alterations of the erectile function are pre-operatively assessed.

Cicatrix↗
PubMed1994

[Realities and limitations of the diagnosis of erectile impotence: radical urethro-prostato-cystectomy as a human experimentalmodel].

Veno-occlusive dysfunction (formerly called "venous leakage") is a clinical-radiographic manifestation of a multi-aetiology syndrome, the pathogenesis of which is to be sought in intrinsic damage to the erectile tissue. It has been attributed to psycho-neurogenic, neurovascular and local--physical factors. The unsatisfactory results of the various surgical techniques proposed (venous ligatures, crural plication, corporopexy) can be explained by the formation of vicarious venous circles, a phenomenon which occurs regardless of the type of procedure adopted and which is the direct consequence of the alteration of the occlusive mechanisms intrinsic to the erectile tissue. At the Urological Institute of the University of Milan, a study has been carried out with the aim of experimentally assessing these aetiopathogenetic hypotheses. 48 sexually potent patients were selected from those scheduled for extensive surgical procedures on account of malignant pathologies of the pelvic cavity (urethro-prostato-cystectomy, radical prostatectomy). The protocol included a series of examinations before and after the operation (at three months): computerised recording of nocturnal erections (NPT test, three consecutive nights), dynamic penile Doppler velocimetry, dynamic cavernosometry/graphy, examination of bulbocavernosus reflex. The goal of the study was to evaluate the haemodynamic consequences of the massive venous ligatures effected during these operations (periprostatic plexus, deep dorsal vein, spongio-cavernous connections). There were 28 cases of radical prostatectomy and 20 cases of radical urethro-prostato-cystectomy. Among the cases of radical prostatectomy, the extrafascial retropubic technique was used for 14 patients, the monolateral nerve-sparing procedure was applied for 10 patients (stage B1) and the transperineal approach was used for 4 patients (the most recent).(ABSTRACT TRUNCATED AT 250 WORDS)

Collateral Circulation↗