Biomedical subjects

V Ficarra

Publications and source records attributed to V Ficarra.

12 recordsLinked to original sources

PubMed2000

Experience in the surgical treatment of Fraley's syndrome.

OBJECTIVE: To report our 20-year experience with nephron-sparing surgery in the treatment of Fraley's syndrome. MATERIALS AND METHODS: From September 1976 to July 1996, 6 women, 18-43 years old, underwent surgical treatment. All patients had been suffering debilitating right flank pain for at least 6 months before the operation. Diagnosis was in call cases made with the use of intravenous pyelography and renal arteriography, which showed a vascular impression on the superior infundibulum with secondary dilatation of the upper pole calyx. This was localized only on the right side in 5 cases, while in 1 it was bilateral though more severe on the right. Ipsilateral nephroptosis was observed in 2 of the patients. In 2 cases in whom the superior infundibulum was sufficiently long, an infundibulo-infundibulostomy with everted flaps was performed. In a case in whom a short infundibulum was compressed between a venous and an arterial branch, Fraley's infundibulopyelostomy was carried out. In 1 patient in whom the infundibulum was compressed by the anterior-superior segmental artery, a Heineke-Mikulicz-type infundibulorrhaphy was combined to vasopexy. In the remaining 2 cases, the infundibulum was not cut: in one case, a simple vasopexy of two vascular branches was carried out, while in the other, a minor arterial branch was ligated and divided. In 4 patients, nephropexy was also performed. RESULTS: No significant intra- or postoperative complications were observed. Follow-up averaged 102.5 months. Pain relief was complete in 5 cases, in whom disappearance of the vascular impression was also radiologically demonstrated. Only 1 patient, who underwent infundibulorrhaphy and vasopexy, experienced occasional flank pain and urinary infection after the operation, with just a slight improvement in the excretory urogram. CONCLUSIONS: Surgical treatment of Fraley's syndrome is indicated only in symptomatic and/or complicated cases; in relation to the type of obstruction and the anatomy of the intrarenal structures, whether excretory or vascular, several effective nephron-sparing techniques can be selected.

Adolescent↗

PubMed2000

General state of health and psychological well-being in patients after surgery for urological malignant neoplasms.

OBJECTIVE: To evaluate the general state of health and the psychological well-being in a group of 155 patients after surgery for urological malignant neoplasms. MATERIALS AND METHODS: Surgery was performed in 55 patients for renal cell carcinoma, in 54 for invasive bladder carcinoma, in 30 for adenocarcinoma of the prostate, and in 16 for squamous penile carcinoma. All patients were invited to self-compile the General Health Questionnaire (GHQ) - 12 items according to Goldberg and the Hospital Anxiety and Depression Scale. Results were compared with those in a group of patients who underwent retropubic prostatectomy for benign prostatic hyperplasia. RESULTS AND CONCLUSION: The general state of health was significantly more impaired in neoplastic patients than in the control group. Levels of anxiety were significantly higher but depression levels were similar in both groups. As far as the type of tumor is concerned, patients who underwent radical cystectomy for bladder carcinoma and those treated with partial penectomy for squamous penile carcinoma showed a significant impairment of the general state of health compared with controls. Higher levels of anxiety were observed in patients who underwent ileal conduit after radical cystectomy, in those treated with radical prostatectomy for prostate cancer and in those who underwent partial penectomy. Significantly higher levels of depression than in the control group were observed only in patients with ileal conduit.

Adaptation, Psychological↗

PubMed2000

[Our experience in the treatment of retroperitoneal fibrosis].

To discuss retroperitoneal fibrosis (RPF) etiopathogenesis and to report on our experience in the treatment of the disease. From 1977 to 1998 26 RPF patients, 15 idiopathic (I group) and 11 secondary (II group), entered our clinic. Vascular risk factors of the I group were cigarette smoking (73.3%) and arterial hypertension (46.6%). Etiologic factors of the II group were aorta abdominal aneurysm (four cases), radiation therapy for female genital tract cancer (four case), aorto-bifemoral bypass for aorta aneurysm (two cases), retroperitoneal non-Hodgkin lymphoma (one case). Treatment performed for idiopathic disease was medical in eight cases (alone in two, with endourologic measures in six) using corticosteroids in five and tamoxifen in three; only endourological in three and surgical in four (nephrectomy in two patients, ureterolysis and ureteroneocystostomy in one, pyeloureterolysis in one) with perioperative corticosteroid treatment in three cases. Treatments performed in patients with secondary disease were endourologic in five surgical in three (ureteroureterostomy, ureteroneocystostomy, pyeloureterolysis and pyeloreduction), medical with corticosteroids in two; one patient affected by perianeurysmatic fibrosis did not require any treatment because of disease's spontaneous recovery. Medical treatment induced symptom remission and plaque reduction in all patients. Surgery determined complete recovery in all patients except for one in whom the disease relapsed with controlateral urinary tract involvement. Medical RPF treatment for idiopathic or secondary disease is effective in the first stage. Disease management with tamoxifen is easy to perform, safe and effective. In the steady state of RPF the best results are obtained by surgery and perioperative glucocorticoid therapy reduced significantly fibrosis' relapse.

Adult↗

PubMed1999

Penetrating trauma to the scrotum and the corpora cavernosa caused by gunshot.

The authors describe a case of gunshot wound of the male genitalia by two low-velocity bullets. The first bullet caused a lesion of the right testicle and came out of the right hemiscrotum; the second one had penetrated the left gluteal region with no exit wound. The penile ultrasound confirmed the presence of the bullet at the root of the right corpus cavernosum. The patient underwent exploratory surgery, drainage of the voluminous bilateral scrotal hematoma, and suture of a laceration of the right-testicle cranial portion. Due to the absence of active bleeding, voluminous hematoma and serious injuries in the corpus cavernosum, no surgical removal of the bullet in the right corpus cavernosum was required. The patient regained a normal sexual function 1 month after the operation.

Adult↗

PubMed1999

Surgical treatment of penile carcinoma: our experience from 1976 to 1997.

OBJECTIVE: The purpose of this work is to evaluate our experience with the surgical treatment of penile squamous carcinoma, analyzing the therapeutic results in terms of local recurrence rates, survival and mortality rates. MATERIAL AND METHODS: From 1976 to 1997, 47 patients were treated at our institution for carcinoma of penis. Treatment of primary tumor was conservative in 8 patients (17%). Partial penectomy was performed in 30 patients (63.8%); total penectomy in 5 (10.7%) and emasculation in 4 (8.5%). Pathological stage was pTis in 2 cases (4.2%), pT1 in 20 (42.6%), pT2 in 21 (44. 7%) and pT3 in 4 (8.5%). The tumor was clinically overstaged in 13 patients (27.7%) and understaged in 4 (8.5%). Bilateral inguinal lymphadenectomy was performed only in 4 patients clinically N+ (pN2) and in 3 clinically N0 (pN0). RESULTS: Local recurrence rate was 43% in the patients with pT1 stage tumor treated conservatively. No local recurrence was observed after penectomy. 19 patients (40.4%) are alive and disease-free; 17 patients (36.2%) died of the tumor and 11 patients (23.4%) died of other causes but disease-free. Mean follow-up is 69.43 months. The overall 5-year survival rate was 34%. CONCLUSION: Partial penectomy gives better results than conservative treatment in the local management of the T1 stage tumor. Survival and mortality rates are related to both pathological and histological stages. The high mortality rate observed in the pT2 stage tumors in our experience might be related to the fact that in this stage an inguinal lymphadenectomy was not performed as a rule.

Carcinoma, Squamous Cell↗

PubMed1999

[Retrograde ejaculation].

Antegrade ejaculation requires intact anatomy and innervation of the bladder neck. Retrograde ejaculation is an uncommon cause of infertility and can be defined as the escape of seminal fluid from the posterior urethra into the bladder. This pathological condition can result from disturbances at the bladder neck due to anatomical lesions, neuropathic disorders or pharmacological influences. Also congenital and idiophatic causes have been described. The diagnosis may be confirmed by findings sperm in post-coital specimens of urine. Pharmacological manipulation, electro-ejaculation and vibro-ejaculation can be utilized to recovery ejaculation. When anterograde ejaculation in this patients cannot be restored artificial insemination using sperm recovered from the antegrade post-coital urine is indicated. The aim of this paper is to evaluate the data of literature on aetiology and therapy of retrograde ejaculation.

Adult↗

PubMed1999

[Comparison of the quality of life of patients treated by surgery or radiotherapy in epidermoid cancer of the penis].

OBJECTIVE: The purpose of our work is to examine how partially or totally radical surgery and radiotherapy can weigh on quality of life in patients with squamous carcinoma of the penis, considering whether quality of life can be a good criterion in treatment options. MATERIAL AND METHODS: We have interviewed 17 patients alive and disease-free (average follow-up 69.43 months) after surgical treatment or radiotherapy for cancer of the penis (emasculation, 2; total amputation of the penis, 2; partial penectomy, 11; radiotherapy, 2). Tests used: General Health Questionnaire (G.H.Q.-12 by D. Goldberg); Hospital Anxiety and Depression Scale (H.A.D.S.); Social Problem Questionnaire (S.P.Q.); Overall Sexual Functioning Questionnaire (O.S.F.Q); Family APGAR Questionnaire (F.A.Q.); Performance Status ECOG. RESULTS: Thirty-five per cent of the patients presented limitations in their state of health and social problems. Anxiety was evident in 29.5% of the patients and depression in 6%. The global sexual function was compromised in 76.5%. CONCLUSION: The profile of quality of life resulted compromised in the patients who had undergone radical surgical treatment. The sexual function was the most altered component. The impact of the pathology and its treatment on the other domains of quality of life proved less significant.

Adult↗

PubMed1998

[Percutaneous, laparoscopic, and surgical treatment of idiopathic varicocele: analysis of costs].

Idiopathic varicocele can compromise the spermatogenetic function of the testicle and associate with alterations of the semen quality. The treatment of varicocele stops the progress of testicular damage and improves spermatogenesis and semen parameters. These are the main alternatives to the traditional surgical treatment of varicocele retrograde percutaneous occlusion of the internal spermatic vein using sclerosing agents and embolizing devices (either separately or in combination), microsurgical ligation via inguinal or sub-inguinal approach, laparoscopic ligation and, more recently, antegrade scrotal sclerotherapy. None of these techniques can be considered the "gold standard" therapy. Literature does not point out any significant difference between them, either considering the absence of reflux percentage, or the improvement of semen quality, or the pregnance rate. Therefore cost comparison may be a valid criterion in the choice of treatment for varicocele correction. The total cost of the surgical retroperitoneal unilateral ligation of the internal spermatic vein is 968,805 Lire, while for the bilateral ligation it is 1,118,285 Lire. The costs of sclerotherapy and percutaneous embolization are respectively of 698,750 Lire and 1,708,950 Lire. The combination of the two techniques amounts to 1,918,230 Lire. Laparoscopic bilateral ligation costs 2,437,935 Lire. Antegrade scrotal sclerotherapy costs 191,035 Lire if unilateral, 216,580 Lire if bilateral. After considering these data we can say that antegrade scrotal sclerotherapy is the first choice economically in the treatment of both unilateral and bilateral varicocele.

Cost Control↗

PubMed1998

[Our experience in the conservative surgical treatment of megaureter in the adult].

Surgical treatment of the megaureter in adults is only indicated when important symptoms and/or complications occur. The Authors report their experience with eight adult patients affected by megaureter, undergone to conservative surgery. The average age of the patients was 36 years (range 21-52). The disease was unilateral in five cases (four on the right side and one on the left), bilateral in three. In five patients megaureter was primary (obstructed in four, refluxing in one). A case of megaureter with ectopic orifice in the prostatic urethra was observed. The remaining two cases, already operated in other hospitals, were a segmentary megaureter associated with vesico-ureteral reflux secondary to endoscopic incision of an ureterocele and a bilateral refluxing megaureter in a patient undergone to bilateral ureterocystoneostomy because of primary megaureter in his childhood. All patients underwent ureterocystoneostomy, performed with Politano-Leadbetter antireflux technique in six cases and with direct non-antireflux technique in two. A reductive Hendren ureteroplasty was also performed in 7 cases. The average length of follow-up is actually of 82 months (range 5-231). Satisfactory results were obtained in three primary obstructed megaureters, in the megaureter with ectopic orifice and in the segmentary megaureter associated with reflux. In two patients with refluxing megaureter surgery was unsuccessful and a new operation was necessary. Finally, one patient with primary obstructed megaureter underwent endoscopic dilatation of the strictured vesico-ureteral anastomosis two months after the ureterocystoneostomy.

Adult↗

PubMed1998

[Long-term results of the veno-occlusive percutaneous treatment of erectile disorders of venous origin].

The treatment of impotence due to venous leakage is remedied by creating an increase in the resistance of the venous outflow in order to trap arterial blood within the corpora cavernosa of the penis during erection. The percentage of success reported in Literature after resection of the deep dorsal vein and ligature of the cavernous veins varies from a minimum of 12.5% to a maximum of 75%. Interventional radiology represents a valid alternative to traditional surgery in the non-prosthesis treatment of erectile dysfunction of venous origin due to the absence of complications and lack of intrusiveness and for the encouraging short and mid term results obtained. From May 1991 to February 1997, seventeen patients (aged between 24-54, average age 36 years) affected by venous leakage underwent embolisation of the principal veins of drainage of the corpora cavernosa. All patients were previously strictly selected in order to exclude those affected by arterial, neurological, endocrine or ++psychological disease. Pathologic venous drainage was shown by pharmacocavernosometry and pharmacocavernosography. The technique employed consisted in isolation and catheterization of the deep dorsal vein of the penis with a cannula needle of 14 G and subsequent ligature and simple section of the vein; venous leakage fluoroscopic evaluation; coils placement under radiological control, in the distal tract of each vein chosen to be occluded; and then at last, embolization of the deep dorsal vein. A fluoroscopic control performed after these procedures showed the correct vascular occlusion. The operation has an average duration of 120 minutes and requires two-day hospitalisation. In 12% (2/17) of the selected cases a technical failure was recorded due to difficult catheterization of the periprostatic plexus, therefore only surgical ligature and section was carried out in the penile deep dorsal vein. Only in one case (6%) there was a slight and transitory oedema of the penis observed. The average follow-up is 34 months (range 3-72 months). Up to now, 11 patients over 15 (73.4%) refer a good improvement of erectile dysfunction together with a satisfactory sexual activity. In two cases (13.3%) only partial improvement have been referred. Only 2 cases (13.3%) did not obtain any benefit from treatment.

Adult↗

PubMed1997

[Polyorchidism: 2 case reports].

Polyorchidism is a rare anomaly with approximately 70 cases reported in literature. The exact explanation for the production of polyorchidism is not known, although several theories have been proposed, including anomalous appropriation of cells, initial longitudinal duplication of the genital ridge and transverse division of the genital ridge, either through some local accident of development of peritoneal bands. A functional classification based upon the embryogenic development is provided. Type I: the supernumerary testis lacks an epididymis and vas. The split-off part of the primordial gonad does not communicate with the mesonephric tubules from which the epididymis develops. Type II: the supernumerary testis is linked to the regular testis by a common epididymis and shares a common vas with it. The division of the genital ridge occurs in the region where the primordial gonads are attached to the mesonephric ducts, although the latter are not divided (incomplete division). Type III: the supernumerary testis has its own epididymis but shares the vas with the regular testis. This variant results from a complete transverse division of the genital ridge. In the majority of the reported cases, the patients are asymptomatic and have painless groin or testicular masses. Approximately 50% occur as maldescent or cryptorchidism, and about 30% are associated with indirect hernia. The remaining 20% are discovered variously in relation to torsion, or are associated with hydrocele, epididymitis, varicocele or infertility. Moreover, since there is a 20 to 40 fold increase in testicular malignancy in patients with cryptorchidism compared with the normal testis, tumours of the supernumerary testicles are not unusual. We reported two cases of polyorchidism: the first patient is probably a longitudinal division of the genital ridge and the second is a completely duplication of the primordial gonads. The patients described vague, intermittent, testicular pain. Physical examination and the scrotal sonography and magnetic resonance revealed in the first patient a supernumerary testis in the right scrotal space and in the second a bilateral double testis. In conclusion we think that in the absence of any concomitant disorder and if testicular tumor can be ruled out by ultrasonography and magnetic resonance imaging, surgical exploration with biopsy is unnecessary.

Adult↗

PubMed1997

[Spontaneous bladder perforation due to eosinophilic cystitis: a case report].

We report a case of eosinophilic cystitis the onset of which was characterized by acute peritonitis secondary to a spontaneous intraperitoneal rupture of the vesical cupula. The patient was treated with urgent partial cystectomy in another hospital and 3 months later he underwent endoscopic diathermic coagulation of a residual inflammatory lesion at our institution. After an 18 month endoscopic follow-up no further signs of recurrent eosinophilic cystitis have been pointed out. The non-traumatic bladder perforation and the absence of any other bladder pathology might indicate that eosinophilic cystitis can be responsible for complete bladder rupture.

Aged↗