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F Mantovani

Publications and source records attributed to F Mantovani.

At least 19 recordsLinked to original sources
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↗
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

[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

[Cavernosography].

Dynamic cavernosography remains today an important step in diagnosis of veno-occlusive impotence, as support to cavernosometry: cavernosometry facilitate the diagnosis and the evaluation of venous-defect, but a contemporary show-timed cavernosography takes many informations about the site of venous-escape; these date allow to perform a correct selective vein ligation or percutaneous procedures, recently introduced in the clinical practice as an alternative or in association with vein ligation. Static cavernous-spongiosography, instead, has many indications in neoplasms and severe malformations.

Adult↗
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↗
PubMed1994

[Erectile function and ablative surgery of penile tumors].

The Authors try to show the possibility to combine radical excision with minimal invasiveness in the surgery of penile cancer. The focal point of every therapeutic decision is correct clinical staging. Unfortunately there's some confusion in the two international staging systems (TNM and Jackson's classification). In fact it's not clear the anatomical difference between epithelioma of the glans infiltrating corpus spongiosum and subcoronary epithelioma of the shaft infiltrating the corpora cavernosa. It's obvious that the infiltration of the corpora cavernosa is a far more aggressive oncological manifestation than that of tumour infiltrating the corpus spongiosum. So we consider Jackson's classification more congenial. In terms of surgery this anatomical independence makes it easy to consider the corpora cavernosa as a distinct entity, so they remain perfectly functional when separated from the glandulo-spongio-urethral unit with its vasculo-nervous bundle. This makes conservation of the erectile function, when clinical staging show us that the tumour is not infiltrating the corpora cavernosa. The Authors show their results, which seem to be rather good.

Humans↗
PubMed1994

[Large cutaneous penile flap in the tubular reconstruction of the urethra in complex recurrent and extensive bulbar-membranous strictures].

The surgical treatment of choice for bulbar-membranous urethral strictures should remove the stricture and achieve an end-to-end anastomosis between two spatulated surfaces to achieve better patency (Turner-Warwick technique [13]). When this is not possible because of recurrence, complex or longer strictures the problem is to choose between various candidate tissue types susceptible of forming a dependable neourethra. With this in view, we have used over the last twenty years a wide range of urethroplastic operating techniques using of scrotal skin [4], bladder mucosa free grafts [3], and dermo-epidermal free mesh grafts [10]. We achieved a significant improvement of the postoperative results with a procedure originally proposed by Quartey [9]. A well vascularised flap is dissected from the whole dorsal penile skin, drawn as far as the perineum and pulled laterally to the cavernous bodies to form the neourethra. We can thus depend on suitable and viable tissue of up to 13 cm in length. A large scalped area of skin is corrected by covering the surface of the penis with a free epidermal mesh graft. Between February 1989 and December 1991, 28 patients with relapsed bulbar-membranous complex urethral strictures underwent urethroplasty with a penile-skin flap. Normal urethro-cystographic imaging and urinary flowmetry figures showed at a three-month follow-up. All patients reported satisfactory micturition and no fistula occurred. Erectile deficiency was not reported.

Adult↗
PubMed1993

[Anatomo-functional changes in the prostate and seminal vesicles with aging].

The anatomo-functional modifications of the prostate and the seminal pathways during the genital apparatus aging, (prostatic hyperplasia and hypotrophy of the seminal pathways and testis), are caused by hormonal modifications (inconstant increase of the gonadotropins LH-FSH, decrease of the peripheric utilization of testosterone, alterations of the adrenal secretion), by anatomical involutions (degenerations of the glandular, stromal and vascular components).

Aged↗
PubMed1993

[Changes in sexuality and fertility in the elderly: ejaculation].

After the remark of the own results on an epidemiological research about andropausal sexual problems, the Authors analyze the alterations of ejaculatory mechanism with elderly, focusing frequency and etiopathogenesis. They underline the need of prevention of ejaculatory disturbances deriving from chronic disease or of iatrogenic origin.

Aged↗
PubMed1993

[Andrologic problems in prostatic carcinoma].

In our opinion, the attempt to save the sexuality and the erectile ability in a patient with a prostate cancer, in the respect of an absolute oncological radicality, should be recommended since potency represents for the patient a primary aspect in the quality of residual life. At the Institute of Urology of the University of Milan a study to identify pathogenetic mechanisms leading to erectile failure in the various phases of a prostate cancer was performed. From January 1988 to December 1993, 36 patients (range 50-60 years old) suffering from prostate cancer B1 stage (14 pts), B2 (20 pts) and C (2 pts) underwent to radical prostatectomy. Out of 24 pts reporting erectile ability before surgery, 10 was in B1 stage and underwent monolateral nerve-sparing technique. Out of these, 6 pts (60%) maintained the erection after the operation. The treatment with LHRH analogues weighted on loss of libido and erectile and erectile potent due to central androgenic delete. At our Institute 87 pts in treatment with LHRH analogues reported loss of erection in 80% of cases. In this group 22 underwent to an andrological examination. The exams (Dynamic penile Doppler, Dynamic Cavernosometry and stimulating test with intracavernous vasoactive drugs) confirm the absence of peripherical damages in the pathogenesis of the erectile dysfunction. Patient underwent radiotherapy develop a secondary impotence due to an obliterant progressive angioitis in a percentage ranging from 30 to 80%.(ABSTRACT TRUNCATED AT 250 WORDS)

Erectile Dysfunction↗
PubMed1993

[Treatment of prostatitis with a new laser probe with optic fiber].

The present treatment of the subacute abatteric prostatitis, prostatodinia, prostatosis (the most common prostatic flogistic diseases) is represented by the transrectal applications of infrared Laser. The concrete opportunity of applying such an energy directly to the prostate in cases of flogistic diseases--a very frequent pathology treated in many different and controversial ways--is a stimulating therapeutical method which we tested and that we presently use in our clinics. The thanks to the realization of an high technology equipment, easy to handle, cheap, safe, perfectly suitable, formed by a new infrared Laser probe, transrectal, atermical, made by a optical fibre, which we present. Micturition, ejaculation, fertility may draw a relevant improvement, provided that the same treatment is performed after a specific medical diagnosis and following a strict protocol.

Equipment Design↗
PubMed1993

Our treatment of congenital complicated penile deviations.

Congenital anomalies of the penis expressed in various forms of flexures can be associated to 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.

Follow-Up Studies↗
PubMed1993

[Treatment of symptomatic bone metastases of prostatic carcinoma using strontium chloride (Sr-89)].

Until now, patients with a progressive prostatic cancer, in whom all therapies failed and the disease spread locally and distally, was considered "a lost patient"; because it did not exist an effective therapy easily to be used. The skeletal pain control is a serious problem and it is a great responsibility also for the Urologists especially if the patient has not a short survival time and the quality of life is very poor. Physicians feel the need for a systemic, well tolerated and effective therapy also for a long time, uniform and repeatable, able to be efficient for these patients. Strontium 89 chloride seems to offer all these possibilities and to be the best procedure for Urologist, Radiotherapists and Nuclear Specialists in order to satisfy the patients requirements. International research has shown Sr-849 Chloride is a powerful new therapy. Sr-89 Chloride is a radiopharmaceutical product for the treatment of painful metastases from prostatic cancer. It is a new treatment but its effectiveness is well documented and results are reported in the most important international literature. In our Department a clinical research has started and our purpose is to produce more data for a clinical and biological evaluation of the results, hoping that a similar research will extend as a multicenter study.

Bone Neoplasms↗
PubMed1993

[Seminal changes of inflammatory origin].

Presence of bacteria in the sperm is often associated to a reduction of fertility in relationship with a decrease in number and motility of spermatozoa and with an augmentation of the abnormal spermatic cells. Clinical features of seminal phlogosis are extremely variable both in acute and chronic evolutions. In every case the first diagnostical step is sperm count and seminal complete analysis which can give evidence of phlogistic alteration in quantity and quality of spermatic cells with a typical presence of an excess in white blood cells (leucospermia) as consequence of infection. The great variety in clinical and bacteriological aspects and the particular biological features of the organs involved, as the prostate, make treatment a difficult problem to solve with particular regard to the choice of an effective antibiotic which pharmacokinetic has to result suitable for the microorganism as well as for the tissue of the infection site. All those efforts are indispensable to reduce the too frequent therapeutical failures in the management of seminal phlogistic pathology with complications of organic but also pathological relevancy for the patient and the partner too.

Anti-Bacterial Agents↗
PubMed1993

[Video laparocystoscopy: diagnostic and operative possibilities].

Bladder endoscopy and videolaparoscopy, both outcomes of human intelligence applied to technology, allow in association, to evaluate bladder proliferent alterations in the depth, providing the possibility to perform a radical treatment, including perithoneum, without risks of ileum injuries. Aim of the method is to increase diagnostic and operative effectiveness of the simple cystoscopy by the adding of the endoperithoneal control of the bladder just by the videolaparoscopy. By this new technique at least two main advantages may be achieved: the check at full thickness of the bladder wall by translightening; the transurethral resection with laparoscopic assistance.

Cystoscopy↗