Biomedical subjects
Publications and source records attributed to G Barbagli.
Granulomatous prostatitis is a rare chronic inflammation and its etiology is not well understood. There is difficulty in differential diagnosis with prostatic cancer. But RMN and ultrasound guided biopsy can confirm the diagnosis. The authors report 15 cases and discuss etiological, clinical and diagnostic aspects.
Twelve men with recurrent anterior urethral stricture after endoscopic urethrotomy (2-12 attempts) underwent open urethroplasty with en bloc removal of diseased urethral segments. Bacteriologic and histologic studies of the excised urethral tracts (mucosa and spongiosum tissue) were performed. The bacteriologic findings were compared with the results of preoperative urine cultures and urethral swabs for chlamydia. The histologic findings were related to preoperative ultrasonographic observations, in order to evaluate the accuracy of ultrasonography in depicting structural changes in spongiosum around the strictured urethral tract. Beta-haemolytic streptococci and Streptococcus faecalis were cultured from the excised spongiosum, without correlation to the preoperative culture results. The histologic studies confirmed the usefulness of urethral ultrasonography for accurate demonstration of the inflammatory changes involving spongiosum around the strictures.
A fifty-four-year-old woman presented with right renal colic and three months later a retroperitoneal tumor was diagnosed. After explorative laparotomy with biopsy, which showed a germ cell tumor, the patient received external beam radiotherapy, but died of metastatic diffusion nine months later. We believe this is a rare occurrence of a germ cell tumor in a postmenopausal woman.
Xanthogranulomatous pyelonephritis occurred in a pelvic ectopic kidney in a 70-year-old man. Pre-operative diagnosis was possible due to the typical appearance at CT scan of central lithiasis and multiple rounded areas of low density with enhancing rims (bear paw sign).
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A case of primary malignant melanoma of the female urethra is presented and the usefulness of an immunohistochemical diagnostic approach is discussed.
Twenty-eight patients with renal cell carcinoma extending to the vena cava underwent surgical treatment consisting of radical nephrectomy and removal of tumor thrombus, which was at the level of the renal veins in 23 cases, the hepatic veins in 4, and extending above the diaphragm in 1 case. In 7 patients lymph nodes were invaded, and 8 had both positive nodes and extrarenal tumor diffusion discovered at surgery. The mean survival was 41.7 months for patients with only venous extension of the tumor, 16 months for patients with positive nodes, and 10.2 months for those with both nodal and extrarenal tumor diffusion.
We report 3 cases of renal cell carcinoma and synchronous bilateral adrenal metastases discovered preoperatively with computerized tomography and other imaging techniques. Surgical treatment consisted of radical nephrectomy through a transperitoneal approach, with adjunctive lower polar resection in a patient with bilateral renal tumors, and contralateral adrenalectomy. Subsequent steroid treatment was given.
A series of 33 posterior urethral strictures in children is presented. The etiology was traumatic in 31 cases and iatrogenic in 2. Complex strictures were treated by a transpubic approach (20 cases) or by a posterior scroto-urethral inlay (1 case). Simple strictures were directly treated via the perineum: by a push-in technique (6 cases); by end-to-end anastomosis (3 cases); by a skin pedicled tube urethroplasty (1 case); by free skin graft (1 case), and by endoscopic urethrotomy (1 case). The use of omentum, employed in 19 cases, is considered a necessary step in transpubic urethroplasty. Favorable results were observed in 18 out of 20 transpubic procedures, in 8 out of 9 perineal urethroplasties and in 3 out of 4 other techniques, with an overall success rate of 87.8%.
Experience with treatment of 38 patients in an early phase with urethral trauma is presented. The site of injury was the penile urethra in three cases, the bulbous urethra in seven, and the prostatomembranous urethra in 28. Different surgical procedures were used, according to the site and the extent of urethral damage and the presence of associated lesions. All patients with penile and bulbous urethral trauma were cured and only one has diminished sexual potency, while in the posterior urethral group nine were cured, and 19 developed strictures requiring further surgical treatment. Total impotence developed in 17 and partial impotence in one patient. Another case presents urinary urge incontinence.
Pelvic trauma, especially when complicated by a posterior urethral disruption, may cause impotence in 50% of patients. The treatment of this kind of impotence has always been troublesome for the urologist. In fact penile prostheses or the revascularization procedures have sometimes been failures. We present a series of 6 patients with impotence after pelvic trauma managed by intracavernous injection of papaverine and we describe here the preliminary results obtained.
Five patients, two men and three women age range 38 to 84 years, were treated for oxyphil cell adenoma of the kidney. Clinical signs were present in three cases and tumor size varied between 7 and 15 cm. Treatment was by nephrectomy in 4 cases and ablation of adenoma in the fifth patient, the tumor being located in the only functioning kidney in the latter. Close follow up surveillance for 32 months failed to detect any recurrence. Clinical and pathologic features of this neoplasm and therapeutic choice in these cases are discussed below. Although radical surgery has been employed in the past as principal therapy, more precise pre- and perioperative diagnosis should allow more frequent use of conservative surgery: partial nephrectomy or tumor excision.
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The technique of bilateral medialization of the ureteral orifices, as proposed by Gil-Vernet, has been used with minor modifications in a series of 14 patients for the surgical treatment of vesicoureteral reflux. Its major advantages are its technical simplicity and bilateral treatment in all cases.
A new technique for the treatment of female stress urinary incontinence is described. It consists of colposuspension obtained by suprapubic placement of two double monofilament sutures in a spiral fashion on the lateral vaginal walls, which are fixed proximally to a Cooper's ligament and tied distally one to the other over the rectus fascia. This technique has been successfully employed in a preliminary series of 26 patients and it appears to be easy to perform and with a wide application range.
9 male patients with rectourethral fistula were treated. Fistulae were congenital in 1 case, iatrogenic in 6 cases and traumatic in 2 cases. In 8 cases we used an abdominoperineal approach with omentoplasty or peritoneal flap; in 1 case a perineal approach was made. In 2 cases it was also necessary to use a transpubic approach to the posterior urethra. Good results were obtained in all cases. The importance of a proper radiological investigation of the fistulous tract and the use of omentoplasty are both emphasized.
Three cases of endovaginal stones associated with vesicovaginal fistulae are described. One fistula was of congenital origin, and the other two were recurrent post-hysterectomy fistulae. Other possible causes of this unusual stone location are neurogenic bladder, ectopic ureteral orifice and vaginal outlet obstruction. The radiologic appearance and the surgical treatment of vaginal calculi are discussed.