Biomedical subjects

G Guazzoni

Publications and source records attributed to G Guazzoni.

At least 55 records · Page 3Linked to original sources

PubMed1994

Prostatic UroLume Wallstent for urinary retention due to advanced prostate cancer: a 1-year followup study.

We attempt to clarify the long-term clinical reliability of the prostatic UroLume Wallstent in the treatment of urinary retention due to advanced prostate cancer. The stent was placed in 11 stage D prostate cancer patients at high surgical risk and with urinary retention unrelieved by total androgen blockade. At preoperative urethroscopy, the bladder neck and verumontanum were clearly visible and not massively infiltrated by tumor. All patients voided spontaneously at the end of the procedure. At 1 year maximum flow nomograms demonstrated the definite relief of bladder outlet obstruction and of related symptoms in the 10 cases evaluated. As expected, the stent had no evident effect on the natural history of prostate cancer. There were no major complications. Bladder outlet obstruction due to advanced prostate cancer and unrelieved by conventional medical therapy can be treated safely and effectively by the prostatic UroLume Wallstent.

Aged↗

PubMed1994

Vascular abnormalities in Peyronie's disease: the role of color Doppler sonography.

We attempted to clarify the role of color Doppler sonography in assessing the vascular function of untreated Peyronie's disease. A total of 50 patients with a mean 20-month history of penile curvature underwent color Doppler sonography with the penis in the flaccid state and after intracavernous injection of 20 micrograms. prostaglandin E1. Of the patients 41 (82%) complained of various degrees of erectile dysfunction, while 9 (18%) reported sustained rigid erections. Pathological peak systolic flow velocities (less than 30 cm. per second) of the cavernous arteries were found bilaterally in 10 patients (20%) and unilaterally in 10 (20%). Peak systolic flow velocity correlated positively with cavernous artery flow volume and with acceleration. Cavernous artery end diastolic velocity and resistance index, measured 15 and 30 minutes after vasoactive injection and genital manipulation, were indicative of corporeal veno-occlusive dysfunction (greater than 10 and less than 0.75 cm. per second, respectively) in 32 patients (65%). Of these patients, 11 (22%) had mixed arteriovenous dysfunction and 9 (18%) had normal cavernous artery flow velocities. Flow along the cavernous arteries is sometimes altered in cases of Peyronie's disease while corporeal veno-occlusive dysfunction seems to be the main hemodynamic abnormality. Color Doppler sonography should be considered as the initial step in the diagnostic evaluation of patients with Peyronie's disease who may be eligible for surgical treatment.

Adult↗

PubMed1994

Open surgical revision of laparoscopic pelvic lymphadenectomy for staging of prostate cancer: the impact of laparoscopic learning curve.

We attempt to clarify the impact of the learning curve on the first 30 laparoscopic pelvic lymphadenectomies performed at our institute. Open surgical revision of the area of laparoscopic dissection was performed at radical retropubic prostatectomy. The mean number of obturator and iliac lymph nodes removed laparoscopically was 8.7 and 8.8 from the right and left sides, respectively. The mean number of residual obturator and iliac lymph nodes removed at open operation was 3.2 and 3 from the right and left sides, respectively. The amount of residual lymph node tissue after laparoscopic lymphadenectomy progressively decreased with time, especially after the first 20 cases. A microscopic pelvic lymph node metastasis was found at open operation in patients 6, 14 and 15, who had false-negative results at laparoscopy. Due to the learning curve effect, the first 30 patients who undergo laparoscopic pelvic lymphadenectomy should be assessed again by an open operation at radical retropubic prostatectomy.

Aged↗

PubMed1994

A modified prostatic UroLume Wallstent for healthy patients with symptomatic benign prostatic hyperplasia: a European Multicenter Study.

OBJECTIVES: This European multicenter study was aimed to assess the clinical reliability of a modified prostatic UroLume Wallstent (American Medical System, Minnetonka, MN) in the treatment of 135 healthy patients with symptomatic benign prostatic hyperplasia. METHODS: Ninety-one patients who were obstructed but still voiding spontaneously and 44 patients who had an indwelling catheter were treated by placement of a modified stent. RESULTS: A significant improvement in mean peak flow rates and residual urine volumes was maintained throughout follow-up. Both obstructive and irritative voiding symptoms were significantly improved after placement of the stent, although a greater amelioration was seen in obstructive symptoms. The rate of patients reporting erections increased after stent insertion. Eighty percent of sexually active patients reported the maintenance of antegrade ejaculation postoperatively. A greater than 80% epithelialization of the stent was seen in 28 patients (100%) examined at the 18-month follow-up. Long-term complications were seen in 51 patients (38%). Twenty-one of these patients had the stent removed due to intractable detrusor instability, stent encrustation, stent migration, or persistence of obstruction due to prominent median lobe, understenting, or severe hyperplasia of the epithelium of the prostatic urethra. In 6 of them another stent was reimplanted while the others were treated surgically. CONCLUSIONS: Although this modified stent was abandoned due to an unacceptable rate of complications, this study demonstrates that bladder outlet obstruction in healthy patients with benign prostatic hyperplasia can be successfully relieved by the placement of a UroLume Wallstent.

Aged↗

PubMed1994

Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study.

OBJECTIVES: The aim of this study was to determine the effectiveness and safety of yohimbine and trazodone used together for the treatment of pure psychogenic impotence. METHODS: Sixty-three patients who had psychogenic impotence diagnosed on the basis of sexual history, results of physical examination, laboratory analysis, polysomnographic recording of nocturnal erections, and dynamic color Doppler sonography of the cavernosal arteries were entered into a randomized, double-blind, placebo-controlled, partial crossover study comparing placebo with yohimbine (15 mg per day orally) and trazodone (50 mg per day orally) used together. Treatment consisted of two 8-week courses. Patients who initially received placebo for 8 weeks were then switched to the 2-drug combination for 8 weeks. Erectile function, ejaculation, interest in sex, and sexual thoughts were investigated at the end of drug treatment and at 3- and 6-month follow-up. For statistical analysis chi-square, McNemar, and Student's t test for unpaired data were used. RESULTS: Fifty-five patients (87%) completed the whole treatment schedule. Positive clinical results (complete and partial responses) were obtained in 39 (71%) patients at the end of the drug treatment phase. These results were significantly better than those obtained with placebo (p < 0.01). Positive results were maintained in 32 (58%) and 31 (56%) patients at 3- and 6-month follow-up, respectively. Minor drug-related adverse effects occurred in 6 (11%) of the patients in the yohimbine-trazodone group and in 2 (4%) in the placebo group. CONCLUSIONS: The combination of yohimbine and trazodone is a safe and effective first-line treatment for psychogenic impotence.

Administration, Oral↗

PubMed1994

Urolume in urethral stenosis: Italian Club of Minimally Invasive Urology experience.

A multicenter study of the patients in whom the Urolume has been implanted has been among the actions undertaken by the Italian Club of Minimally Invasive Urology (UMICLUB). For each patient, a computer information format has been prepared containing evaluation data related to the preoperative period, the endoscopic procedure, and follow-up. The collected data were computerized through unifunctional and multifunctional analysis. Of the 82 patients recruited, 76 were followed for a period ranging from 1 to 40 months. Urinoflow results dramatically improved after implantation of the endoprosthesis: peak flow rates increased by 310%, while mean flow rates increased by 294%. Incontinence and dribbling were found in 4% and 20% of the patients, respectively, and were independent of the distance between the external sphincter and the Urolume prosthesis and of the stent number and length. The cross-data elaboration seems to indicate a statistically significant relation between urethral preparation before Urolume implantation and stricture recurrence, with recurrence being more frequent after dilation. Significant correlations have not been noticed between stenosis etiology, urinary infection, type of anesthesia, and recurrence; between the type of anesthesia, stent length, and duration of hospitalization; or between stent number and position and pain. The impact of the Urolume prosthesis on sexual activity was marginal by all three measures considered (pain during erection, coitus, and ejaculation).

Adult↗

PubMed1994

Significance of full nocturnal erections with short duration.

The aim of the study was to clarify the pathophysiologic significance of full but short-lived nocturnal erections observed in some impotent men. Penile circulation was assessed by color Doppler sonography and pharmacocavernosometry in 35 impotent patients who underwent polysomnographic recording of nocturnal erections. In each case, there were at least 3 erectile episodes with a complete rigidity (always > 700 g) but with a short duration (mean duration of the maximum level of full erection = 4 min; always < 6 min). All patients demonstrated a normal arterial inflow with mean +/- SEM right and left cavernosal peak flow velocities of 39.5 +/- 1.8 and 41.3 +/- 1.5 cm/s, respectively. Pharmacocavernosometry detected a dysfunction of the cavernous veno-occlusive mechanism (mean +/- SEM maintenance flow: 45 +/- 8 ml/min and mean +/- SEM corporal pressure decay over 30 s: 82.5 +/- 9 mm Hg) in 18 patients (51%). In these patients, this finding may be a possible explanation for the short duration of nocturnal erectile episodes. In the remaining 17 patients (49%) with normal penile vascular status, a dysfunction of the adrenergic system could play a role in the pathophysiology of this picture. Full but short-lived nocturnal erections, as assessed by polysomnographic recording, are indicative of a normal arterial status and should encourage further assessment of the corporal veno-occlusive mechanism.

Adult↗

PubMed1994

The use of wallstents in patients with benign prostatic hyperplasia.

This study was conducted to assess the clinical reliability of the prostatic Urolume Wallstent for symptomatic BPH patients. One hundred patients were treated under intravenous sedation or local anesthesia. Pre- and postoperative patient evaluation included scoring of subjective symptoms, physical examination, laboratory analysis, transrectal ultrasonography, uroflowmetry with maximum flow nomograms, intravenous pyelogram and cystourethroscopy. At the long-term follow-up the vast majority of patients showed non-obstructed voiding parameters. The most frequent complications included stent malpositioning and dislocation, and persistent irritative symptomatology. The prostatic UroLume Wallstent is a safe and effective minimally invasive procedure for carefully selected BPH patients.

Aged↗

PubMed1993

Is there a role for transrectal microwave hyperthermia of the prostate in the treatment of abacterial prostatitis and prostatodynia?

Transrectal microwave hyperthermia of the prostate was administered to 54 patients with chronic abacterial prostatitis or prostatodynia, who failed to respond to several courses of conventional therapies. Hyperthermia was delivered in 60-min long sessions with three randomly chosen regimens (1 session/week for 4 weeks; 1 session/week for 6 weeks; 2 sessions/week for 3 weeks). A prostatic temperature of 42.5 +/- 0.5 degrees C was maintained throughout the entire duration of each session. Patients were assessed pre- and postoperatively by scoring of subjective symptoms, uroflowmetry with flow nomograms, determination of residual urine volume, and transrectal ultrasonography of the prostate. At the long-term follow-up, the subjective symptom score was significantly improved in all patients. Fifty percent of the patients also reported an improvement of life quality, 47% reported their condition unchanged, and 3% reported deterioration, despite therapy. Urodynamic parameters improved but did not reach statistical significance. No major complications were encountered. Our preliminary data indicate that transrectal microwave hyperthermia of the prostate is a safe therapy that can be beneficial as a second line treatment in selected patients with recurring symptoms of abacterial prostatitis or prostatodynia, which do not respond to medical therapy.

Adult↗

PubMed1993

Effectiveness and safety of multidrug intracavernous therapy for vasculogenic impotence.

A four-drug vasoactive mixture (papaverine hydrochloride, prostaglandin E1, phentolamine mesylate, atropine sulfate) was used for intracavernous injection therapy in 94 patients with vasculogenic impotence as diagnosed by color Doppler sonography and dynamic infusion cavernosometry-cavernosography. At a mean follow-up of twenty months, 66 patients (70%) are using the injections with the initial dose and are satisfied; 14 patients (15%) are using the injections with a smaller dose than initially given; and 14 patients (15%) dropped intracavernous treatment. Only 4 patients (4%) were unable to achieve a sustained rigid erection during the mixture titration phase. Selected cases of vasculogenic impotence can be safely and effectively treated by the association of drugs which rely on different mechanisms of action, producing a pharmacologic synergism which enhances the overall therapeutic effect.

Alprostadil↗

PubMed1993

Prostatic UroLume Wallstent for benign prostatic hyperplasia patients at poor operative risk: clinical, uroflowmetric and ultrasonographic patterns.

The prostatic UroLume Wallstent was positioned in 30 poor operative risk patients with bladder outlet obstruction due to benign prostatic hyperplasia. Preoperatively, 12 patients (40%) could still void spontaneously (group 1), while 18 (60%) had an indwelling catheter (group 2). Preoperative and postoperative assessment included scoring of subjective symptoms, physical examination, uroflowmetry with maximum flow nomogram, transrectal ultrasonography of the prostate, determination of residual urine volume and cystourethroscopy. All but 1 patient could void spontaneously after insertion of the stent. In group 1 preoperative and 1-year followup mean (plus or minus standard error) peak flow rates were 8.0 +/- 0.7 ml. per second and 15.8 +/- 1.8 ml. per second, respectively (p < 0.01), the mean residual urine volumes were 127 +/- 27 ml. and 38 +/- 11 ml. (p < 0.05), respectively, and the mean maximum flow nomograms (plus or minus standard deviation) were -2.6 +/- 0.1 and -1.4 +/- 0.4, respectively. In group 2 the 1-year followup mean peak flow rate, residual urine volume and maximum flow nomogram were 13.2 +/- 0.8 ml. per second (standard error), 32 +/- 14 ml. (standard error) and -1.5 +/- 0.1 (standard deviation), respectively. According to the maximum flow nomogram values all patients were nonobstructed postoperatively. At 1 year the stent was completely covered by prostatic epithelium in 90% of the patients, while in the remainder it was still partially visible at urethroscopy. Transrectal ultrasonography had an essential role in patient followup by accurately assessing the position of the stent. Placement of this prostatic stent is safe and effective for selected benign prostatic hyperplasia patients who cannot undergo surgical treatment due to poor operative risk.

Aged↗

PubMed1993

Patient-partner satisfaction with semirigid penile prostheses for Peyronie's disease: a 5-year followup study.

The long-term acceptance of and satisfaction with penile prostheses were assessed in patients with Peyronie's disease and their partners. From 1985 to 1987, 50 men with advanced Peyronie's disease and associated erectile dysfunction were treated with a semirigid penile implant without additional plaque surgery. A total of 48 patients and 29 partners was reassessed at a followup of at least 60 months. Only 23 patients (48%) and 12 partners (40%) were totally satisfied with the long-term functional result and would repeat the same operation. Among the 25 dissatisfied patients (52%) loss of complementary erection resulting in a pencil-like penis, decrease in penile sensitivity, poor concealment and persistence of penile deviation were the major complaints. Of the partners 17 (60%) were dissatisfied due to poor penile girth, sensation of a cold glans penis, sensation of unnatural intercourse and dyspareunia. Eight patients (16%) chose to substitute the semirigid implant with a 3-component inflatable prosthesis. On a long-term basis, placement of a semirigid penile prosthesis for Peyronie's disease is associated with a significant patient-partner dissatisfaction rate.

Erectile Dysfunction↗

PubMed1993

Intracavernous vasoactive pharmacotherapy: the impact of a new self-injection device.

The clinical effects of a new self-injection pen were investigated in 160 impotent patients undergoing intracavernous vasoactive pharmacotherapy. Of the patients previously using insulin syringes for self-injection 90% switched to the pen, since it was considered easier to use and several injections could be performed with the same drug cartridge, thus avoiding the preparation necessary before every single injection with the syringe. Dropout rates were 36% and 12% for patients using the syringe and the pen, respectively (p < 0.05). This self-injection pen can be used for any drug, either singly or in combination with others. It is well accepted by patients, and greatly increases acceptance of and satisfaction with intracavernous pharmacotherapy.

Alprostadil↗

PubMed1993

Four-drug intracavernous therapy for impotence due to corporeal veno-occlusive dysfunction.

Although veno-occlusive dysfunction is a frequent cause of impotence, a definitive therapeutic strategy has not yet been clearly defined. A total of 56 patients with corporeal veno-occlusive dysfunction diagnosed by dynamic infusion cavernosometry-cavernosography (flow to maintain erection greater than 10 ml. per minute and rate of corporeal pressure decrease after interruption of intracavernous infusion greater than 50 mm. Hg for 30 seconds) not considered suitable candidates for surgery underwent self-injection therapy. A vasoactive mixture composed of 12.1 mg./ml. papaverine hydrochloride, 10.1 micrograms./ml. prostaglandin E1, 1.01 mg./ml. phentolamine mesylate and 0.15 mg./ml. atropine sulfate was used. After dose titration of the drug mixture 54 patients (95%) were able to obtain sustained rigid erections that guaranteed satisfactory sexual activity. Mean (plus or minus standard error of mean) volume of injected mixture was 0.42 +/- 0.09 ml. (range 0.25 to 0.90 ml.). Four patients (7%) reported transient hypotension that did not recur after the application of a penile rubber band before injection. At a mean followup of 16 months 6 patients (11%) discontinued use of injections, 37 (69%) were satisfied and using the mixture, and 11 (20%) maintained rigid erections using a lower than initial dose. No major complications were encountered. The association of drugs with different mechanisms of action caused a synergism that potentiated the therapeutic activity and reduced side effects by decreasing the total drug dose.

Alprostadil↗

PubMed1993

Prostatic spiral versus prostatic urolume wallstent for urinary retention due to benign prostatic hyperplasia. A long-term comparative study.

Thirty-eight high-risk surgical patients with urinary retention due to benign prostatic hyperplasia (BPH) were treated by placement of a prostatic spiral under local anesthesia (group 1: 20 patients) or a prostatic stent under intravenous sedation (group 2: 18 patients). At the 1-year follow-up, mean peak flow rate, residual urine volume and subjective symptoms scale were significantly better in the stent group (p < 0.01). The rate of postoperative urinary incontinence and dislocation of the device was greater in the spiral group. Cystoscopic manipulation and removal of the device were definitely easier with the spiral. Both the prostatic spiral and stent have specific roles in the treatment of urinary retention in the unfit BPH patient. The selection of the most suitable device depends on accurate patient assessment.

Aged↗

PubMed1993

Transcoccygeal radical prostatectomy for localized prostate cancer: early clinical results.

Twelve patients with adenocarcinoma of the prostate underwent radical transcoccygeal prostatectomy. The methodology and outcome are described. Preoperative laparoscopic lymphadenectomy was performed on all patients. The average operative time for the prostatectomy using the transcoccygeal route was 3 h and 7 min, and no major postoperative complications occurred. Compared to the classic retropubic approach, preservation of the neurovascular bundles and urethral anastomosis seemed to be facilitated. It was concluded that radical prostatectomy can be performed safely using the transcoccygeal approach.

Adenocarcinoma↗

PubMed1993

Long-term clinical reliability of transurethral and open prostatectomy for benign prostatic obstruction: a term of comparison for nonsurgical procedures.

To elucidate the long-term reliability of prostatectomy, we evaluated 92 benign prostatic hyperplasia patients who had been submitted to either transurethral or open surgery at the 5-year follow-up. Ninety-five percent of the patients were still nonobstructed and subjectively satisfied of their urinary status. Postoperative mortality was presumably not related to the previous operation. Until now, nonsurgical procedures did not guarantee the results achieved by surgical treatment and should thus be reserved for patients at high operative risk or refusing surgery.

Follow-Up Studies↗

PubMed1993

Velocity and flow volume gradients along the cavernosal artery: a duplex and color Doppler sonography study.

Duplex and color Doppler sonography were used to assess 130 impotent patients and 8 potent controls. Cavernosal artery diameter, peak flow velocity and volume flow rate were evaluated at the level of the crura of the corpora cavernosa and 1 cm proximal to the corona penis. Potent controls and nonarteriogenic impotent patients showed a 20% reduction in hemodynamic parameters at the periphery of the cavernosal arterial tree. In patients with occlusive disease, involving either the upper arterial tree or the entire course of the cavernosal artery, the gradient was maintained. In patients with selective occlusive disease of the distal segment of the cavernosal artery the hemodynamic gradient almost doubled. Hemodynamic gradients can be identified along the cavernosal artery and provide additional information to arteriographic data for the selection of candidates for penile vascular reconstructive surgery.

Arterial Occlusive Diseases↗