Biomedical subjects

Massimiliano Nicola

Publications and source records attributed to Massimiliano Nicola.

5 recordsLinked to original sources

PubMed2006

Bladder hernia.

Bladder hernia is a rare condition, but crural herniation of the bladder into the scrotum is very rare. A case of bladder hernia presenting with urological symptoms is described. A 71-year-old man presented to the urological ward complaining for persistent frequency and nocturia associated with loss offorce and decrease of caliber of the urinary stream and the presence of a large mass of the right scrotum. An IVP (intra venous pyelography) showed a large herniation of the bladder through the right inguinal canal into the scrotum. An inguinal incision was made and a crural hernia was identified. The hernia sac, containing bowel and bladder, was dissectedfreefrom the spermatic cord and the testis and the hernia defect was repaired.

Aged↗

PubMed2005

'Straightening-reinforcing' technique for congenital curvature and Peyronie's disease.

OBJECTIVES: We report an initial randomised study on surgical techniques with subsequent intensive application of our procedure. MATERIALS AND METHODS: We modified Ebbehoj-Metz technique by a 'straightening-reinforcing' (S-R) double stitch: the first performs the plication, the second tightens it, thus preventing tension during erection. This is different to the simple Ebbehoj-Metz stitch that only provides plication but, as it does not provide reinforcement, does not prevent recurrence. From 1995 to 2000 78 plications were performed: 60 for congenital curvatures (age range 18-32 years) and 18 for Peyronie's disease (PD; age range 36-58 years). During the first 3 years, i.e. between 1995 and 1998, patients were randomised to S-R plication (20 congenital and 5 PD) and Nesbit procedure (20 congenital and 5 PD), for a total number of 50 patients (40 congenital and 10 PD). The last 28 patients, operated between 1998 and 2000, were assigned exclusively to S-R plication. We delayed study publication in favour of an adequate follow-up. RESULTS: No patient reported a decrease in erectile function and all reported easy vaginal penetration within 3 months. In 60% of the patients undergoing the Nesbit technique, restoration of a fully satisfactory coital activity was delayed because of pain during erection; 35% of all patients had some problems with the coronal suture which disappeared 1 month after the operation, and 15% reported decreased sensibility of the glans. Recurrence rate was not significant for all patients of all groups, even if 3 PD patients of the S-R plication group and 1 PD patient of the Nesbit group received no benefit from the operation. CONCLUSION: S-R plication is not better than the Nesbit procedure. However, for low degrees of penile bending, both congenital and acquired, we do not think it strictly necessary to perform the more invasive Nesbit operation (requiring opening of Buck's fascia, detachment of the neurovascular dorsal bundle or urethra and albuginea excision). Modified plication may be a minimally invasive and effective treatment suitable for most curvatures treated in day clinics and under local anaesthesia.

Adolescent↗

PubMed2005

Prospective comprehensive assessment of sexual function after retropubic non nerve sparing radical prostatectomy for localized prostate cancer.

OBJECTIVES: This prospective study was undertaken to assess sexual function according to a multidisciplinary comprehensive approach in patients with localized prostate cancer who were treated with radical prostatectomy. MATERIALS AND METHODS: Patients with localized prostate cancer scheduled to undergo retropubic radical non nerve sparing prostatectomy participated to the study. International Index of Erectile Function (IIEF) and Self-rating Depression Scale (SDS) questionnaires were administered and patients were interviewed by a psychologist about their sexual function before and 1 month and 3 months after surgery and underwent nocturnal penile tumescence (NPT) monitoring for 3 nights before and 3 months after radical prostatectomy. After surgery patients were offered sexual counselling and were encouraged to experiment with oral treatment for erectile dysfunction. At 24 month follow up patients were interviewed asking for information PSA value, continence and sexual status. RESULTS: At basal IIEF score showed erectile dysfunction at various degree in 40%, SDS score demonstrated a mild depression in 10% and NPT tests showed a number or erectile episodes less than 3 in 30%, a total time of erection less than 60 minutes in 43% and a degree of rigidity less than 70% in 66%. IIEF scores were inversely related to SDS scores (r = -0.43, p < 0.012) and SDS scores were inversely related to time of erection at NPT (r = -0.44, p = 0.016). The mean basal IIEF score was significantly higher than the 1-month IIEF (p = 0.000) and 3-month IIEF score (p = 0.001) and the mean basal SDS score was significantly higher than the 3-month SDS score (p = 0.011). The mean degree of erections (p = 0.000), total time of erection (p = 0.004) and degree of erection (p = 0.003) at basal were significantly higher than at 3-month follow up. At 24 month follow up five patients replied that they were not able to achieve any erection (group A), 4 were able to achieve an erection only after intracorporeal injection of prostaglandins (group B), 3 were able to achieve erection after oral treatment with sildenafil and only one stated to be able to achieve spontaneously an erection sufficient to sexual intercourse (group C). The mean values of basal IIEF and SDS score at basal and the degree of erection at basal were not significantly different in the three groups whereas the mean number of erections and the mean total time of erection at basal NPT tests were significantly higher in group C than in group A and B. CONCLUSION: Severe erectile dysfunction was observed in most patients after retropubic radical non nerve sparing prostatectomy, but 50% of candidates for radical treatment presents with abnormal erectile function before surgery when appropriately studied. Patients who will recover erectile function could be identified by NPT test before surgery. Depression associated with the fear for intervention is related with erectile dysfunction measured by IIEF scores before surgery, but depression index scores improve after surgery showing that the role of depression in the maintenance of erectile dysfunction is marginal. Sexual counselling and oral treatment facilitate recovery after surgery in patients with optimal erectile function before treatment.

Aged↗

PubMed2003

[Anatomical and clinical correlations in the cerebellar eredodegeneration].

Spinocerebellar hereditary degeneration makes up a heterogeneous group of diseases headed by Strumpell-Lorrain syndrome and Friedreich's disease. They are a heterogeneous group characterized by spasticity and paraplegia and related to demyelinization of the pyramidal tract and of the posterior cordons. During a 4-year period, we studied 14 patients (42-61 years old) suffering cerebellar eredodegeneration (hereditary ataxia). The aim of our work was to correlate anatomopathological findings with clinical signs. The important role played by the cerebellum in vesicosphincterial coordination was shown; in particular severe alteration of the ponto-cerebellar bundles could be cause of the abnormal behaviour of the detrusor.

Adult↗

PubMed2002

[Reconstructive urethroplasty using porcine acellular matrix: preliminary results].

OBJECTIVE: The use of "porcine acellular matrix", obtained from small intestine submucosa, could simplify the repair of long urethral strictures, whereas single stage techniques can be carried out only by means of grafts, as buccal mucosa; or flaps, as prepucial skin. To our knowledge we report the first use of porcine intestine submucosa in urethroplastic surgery. MATERIALS AND METHODS: From May 2001 to December 2001, five urethral reconstructions were completed using "porcine acellular matrix". Four male patients had urethral strictures longer than 10 cm. After circumcision and penile degloving, we extended the surgical approach to the perineum-scrotal region by a midline longitudinal incision. The urethra was exposed, dissected from corpora cavernosa, then rotated of 180 degrees and on this side longitudinally incised throughout all the stenotic length. Urethroplasty was accomplished with matrix tissue modelled according to the length of the stenosis and grafted by a 5-0 polyglycolic acid running suture. The enlarged urethra was then derotated, laying the graft dorsally, closed to corpora cavernosa, to prevent pouching. A further graft was accomplished in a female patient with a 3 cm long urethral stricture. All urethroplasties were stented for 14 days. No complication developed. RESULTS: After 1 month urethral patency was satisfactory compared with preoperatory images and the urinary flow was normal. After 2 months the urethra was endoscopically verified: it was easy to appreciate the homogeneous transformation of the graft into the native tissue. At 6-month follow-up radiological and urodynamic outcome is still satisfactory in all patients. CONCLUSIONS: According to our preliminary experience "porcine acellular matrix" is a promising approach for the repair of long urethral strictures. Its safety and effectiveness encourage us to treat more cases in male and female patients.

Aged↗