D. Porru - Academia.edu (original) (raw)
Papers by D. Porru
Carissimi Colleghi e Soci, grazie alle fatiche della Commissione, coordinata splendidamente da Ro... more Carissimi Colleghi e Soci, grazie alle fatiche della Commissione, coordinata splendidamente da Roberto Migliari, e dell'editore Alberto Mandressi, e grazie alla collaborazione generosa dell'Alfa Wassermann, ho il piacere di presentarVI una nuova AUROLINE. Cimentarsi con i disturbi urinari nella donna era un compito titanico tipico delle imprese della nostra Associazione, sia per la complessità dell'argomento sia per la "fisiologica" multidisciplinarietà. Essere riusciti nell'impresa in un solo anno non è cosa da poco e conferma ancora una volta che l'AURO.it parla principalmente coi fatti. Ormai da anni produciamo una linea guida all'anno, con impressionante regolarità, linne guida che costituiscono un prezioso strumento di lavoro per moltissimi urologi italiani. Il prossimo impegno sarà la linea guida sui LUTS e sull'IPB e nel frattempo inizieremo l'opera di aggiornamento delle prime linee guida. Sappiamo che qualcuno preferirebbe un' Associazione con più parole, più complotti, più ricatti, più cose insomma di cui parlare nei corridoi sorseggiando un caffè, ma che volete farci, noi siamo fatti così....
The prevalence of interstitial cystitis/painful bladder syndrome (IC/PBS) among gynecologic patie... more The prevalence of interstitial cystitis/painful bladder syndrome (IC/PBS) among gynecologic patients attending vulvar disease or pelvic pain clinics is higher than expected. The evaluation of gynaecologic charateristics in patients with IC/PBS could be important to delineate a better therapeutic strategy. We compared clinical gynecologic characteristic including localized and generalized vulvodynia and sexual activity of 47 women with a definite diagnosis of IC/PBS versus 47 negative controls. The prevalence of both generalized or localized vulvodynia was 85.1% in the patients and 6.4% in the control group. The mean visual analogue score on generalized or loclaized vulvodynia evaluated with the Cotton-swab test was 6.1+2.6 among women with IC/PBS and 0.6+1.7 in the control group. Pain during intercourse was described as unbearable by 15 women with IC/PBS and 2 controls. Sexual function was significantly impaired in women with IC as measured by the median total score of the Female Se...
European Urology, 1996
We analyzed preoperative and postoperative urodynamic parameters in 26 patients who underwent tra... more We analyzed preoperative and postoperative urodynamic parameters in 26 patients who underwent transurethral prostatic resection with the aid of a computer program. The parameters URA, W and Wmax were evaluated: URA affords a monitoring of the removal of obstruction, while Wmax and W function monitor changes in detrusor contractility, which appear significant after prostatic resection in obstructed patients. Many patients had a fading contraction, that is detrusor contractility decreased during micturition: in most of them the removal of obstruction restored this pattern to normal. Evaluation of these parameters is recommended for preoperative assessment and postoperative follow-up.
European Urology, 1997
We report on a 50-year-old woman first treated by us in 1990 for uroseptic fever. Urography showe... more We report on a 50-year-old woman first treated by us in 1990 for uroseptic fever. Urography showed occlusion of the terminal tract of the lower third of the left ureter. The patient was submitted to successful left ureteroneocystostomy (UNCS). Three months later, she had a relapse of uroseptic fever, and urography showed right ingravescent dilation and excellent functional activity of the left urinary tract. Right UNCS was performed. A further relapse on the right side was again treated with UNCS and psoas-hitch bladder, but both the dilation and the occlusion persisted. Considering the state of the patient, and in order to remove the right nephrostomy that had been applied in the meantime, and to reduce the state of inflammation in view of further surgery, it was decided to treat the right ureteral total stenosis with ureteroscopic resection through the ureter facilitated by an other luminous flexible ureteroscope inserted upstream via nephrostomy. This technique is based on concepts searching for stenotic ureteral zones in transplanted kidneys, with the help of an adequate luminous catheter. An X-ray follow-up 9 months later evidenced that the maneuver was totally successful.
European Urology, 1997
Different etiopathological mechanisms of enuresis are today under study, and different therapies ... more Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin. 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders. Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a 'good' (6-7 dry nights/week) or 'intermediate' response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success. The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.
European journal of physical and rehabilitation medicine, Oct 12, 2016
Pain represents a common problem in the setting of neurorehabilitation, in that it is a common ou... more Pain represents a common problem in the setting of neurorehabilitation, in that it is a common outcome measure but may also have a negative effect on motor and cognitive outcomes. Guidelines, expert opinions or consensus statements on pain in neurorehabilitation are largely lacking. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted to answer some questions on this topic, and its recommendations may offer practical and useful information and represent the basis for future studies on pain in neurorehabilitation.
Archivos españoles de urología, 1998
The aim of our study was to analyze the effect of gynecological dysfunction on voiding symptoms i... more The aim of our study was to analyze the effect of gynecological dysfunction on voiding symptoms in women. A modified AUA symptom index questionnaire was self-administered and an ambulatory home uroflowmetry was performed, using a specially designed home uroflowmetry apparatus for multiple flow measurements. Urinary symptoms and home uroflowmetry (Home Urodata TM System) were evaluated in 68 women: 34 patients with gynecological dysfunction, and 34 normal controls. A total of 156 urination episodes was recorded, with a mean of 5.4 measurements per patient. Symptom index showed lower values in the group of normal controls than in the group with gynecological dysfunction. Voided volume, peak flow rate and average flow rate were all significantly better in the group of normal controls than in the group with gynecological disorders; the most remarkable changes were observed in patients with genital prolapse and with large uterine fibroma. In both groups the total urine volume was lower b...
Annales d'urologie, 1999
This article examines the technical modalities or ureteral catheterization. The authors also disc... more This article examines the technical modalities or ureteral catheterization. The authors also discuss unconventional modalities which, if used without prejudice, can sometimes constitute brilliant and economic solutions to complex problems which are often impossible to resolve otherwise. After a summary of the history of ureteral catheterization, the authors present the main indications for temporary ureteral catheterization: radiographic and fluoroscopic examination of the ureter; separate cytological harvesting; separate bacteriological harvesting; confirmation of the side of unilateral haematuria; preliminary temporary dilatation of the ureter to prepare it for ureteroscopy; temporary drainage of the excretory tract after endourological investigation. The authors also present particular situations may be observed temporary catheterization, or even permanent stenting, for example in the case of procedures in children, pregnant women and renal transplant recipients.
European Urology Supplements, 2008
Objectives- The aim of our study was to test the effect of a more viscous compound than existent ... more Objectives- The aim of our study was to test the effect of a more viscous compound than existent hyaluronic acid formulation in helping to restore a defective glycosaminoglycan layer, and therefore in improving Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) symptoms when administered intravesically in IC/PBS patients. Methods- A total of 23 female patients completed the study. Patients received endovesical administration of hyaluronic acid and chondroitin sulfate in normal saline, 40 ml, weekly for 12 weeks and then bi-weekly for 6 months, if there was initial response. Results- After 12 weeks treatment both Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), pelvic pain and Urgency/Frequency Symptom Scale (PUF) showed a mean significant improvement, which was maintained thereafter. The average number of voidings and mean voiding volumes revealed significant improvement after the 12 weeks treatment period, with a significant reduction and increase, respectively. Mean voiding volume increased from 143 ml to 191, which apparently was not reflected in a corresponding reduction of number of daily voids (from 15,5 to 14). VAS values decreased from 5,4 to 3,6 (pain) and from 6,0 to 3,5 (urgency) after the treatment cycle, showing a significant improvement. Conclusions- In our preliminary experience, the administration of intravesical hyaluronic acid plus chondroitine sulphate appears to be a safe and efficacious method of treatment in IC/PBS.
European Urology Supplements, 2008
Journal of Pharmaceutics, 2013
Bladder pain is a characteristic disorder of interstitial cystitis. Diazepam is well known for it... more Bladder pain is a characteristic disorder of interstitial cystitis. Diazepam is well known for its antispasmodic activity in the treatment of muscular hypertonus. The aim of this work was to develop and characterize vaginal pessaries as an intravaginal delivery system of diazepam for the treatment of interstitial cystitis. In particular, the performance of two types of formulations, with and without beta-glucan, was compared. In particular, the preparation of pessaries, according to the modified Pharmacopeia protocol, the setup of the analytical method to determine diazepam, pH evaluation, dissolution profile, and photostability assay were reported. Results showed that the modified protocol permitted obtaining optimal vaginal pessaries, without air bubbles, with good consistency and handling and with good pH profiles. In order to determine the diazepam amount, calibration curves with good correlation coefficients were obtained, by the spectrophotometric method, using placebo pessari...
Urologia Internationalis, 1994
The study included 18 men, submitted to urodynamic investigation 9-18 months after cystoprostatec... more The study included 18 men, submitted to urodynamic investigation 9-18 months after cystoprostatectomy for bladder cancer and bladder substitution with a detubularized ileal segment as described by Studer-Zingg. Sixteen patients were continent by day and 3 were incontinent during the night so as to require the use of a condom catheter. The residual urine was over 100 ml in 3 patients, while it was low or absent in the remainder. Micturition was performed by straining, and maximal flow rates were normal, although the pattern was intermittent. The incidence of nocturnal incontinence was 55.5%. Measurement of the urethral pressure profile revealed a shortened functional length, and low pressure was found in 3 patients, with a maximum urethral closure pressure < 45 cm H2O. During extramural ambulatory urodynamic monitoring, pressure values in the neobladder usually ranged below 20 cm H2O and exceeded 34 cm H2O in only 2 patients who complained of daytime and nocturnal incontinence. The urodynamic features of the neobladder in patients who underwent radical cystoprostatectomy and bladder replacement with a detubularized ileal segment indicate low pressure at high-level filling.
Spinal Cord, 1996
We report on a 16-year old patient with a neuropathic bladder secondary to Behcet's disease, whic... more We report on a 16-year old patient with a neuropathic bladder secondary to Behcet's disease, which is an uncommon vasculitis usually involving venules. The genitourinary manifestations of this disease are discussed, a neuropathic bladder being a rare complication of the involvement of the nervous system. Urodynamic assessment is important when voiding dysfunction is present; three patients previously reported revealed a bladder function changing from normal detrusor to overactivity. Our patient showed early and severe involvement of the nervous system, and detrusor areflexia two years after the onset of the disease. Spontaneous voiding was restored two months after urological management (intermittent catheterization) was started.
Prostate Cancer and Prostatic Diseases, 2005
A group of 107 patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargemen... more A group of 107 patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE) participated to the HOUSE Study (Home and Office Uroflowmetry Specific Evaluation). Patients received routine investigation, consisting of medical history taking, physical examination including digital rectal examination, prostate-specific antigen (PSA), assessment of symptoms listed both on the International Prostate Symptom Score and on ICS-male questionnaire. We examined the results of uroflowmetry evaluation in this population; data were analysed to observe if any circadian changes of parameters obtained with home uroflowmetry could be detected. We searched a correlation between Q max , Q ave and ICS-benign prostatic hyperplasia symptom score: a significantly inverse correlation was found only for Q max , confirming Q max as a reliable parameter to quantify subjective symptoms. When examining the multiple flow curves recorded in the same patient with home uroflowmetry, voided volume and flow time had usually higher values during night-time: the existence of circadian changes of uroflowmetry parameters in patients with LUTS from BPE was confirmed, and lower values of average and maximum flow rates during sleep hours were recorded in the same patient. In conclusion, when evaluating the natural history or treatment outcome of individual patients or group of patients in clinical trials for evaluation of BPE and LUTS, an assessment including multiple measurements may be useful and of value.
Neurourology and Urodynamics, 2000
We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters... more We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters, urinary incontinence, post-micturition dribbling, and quality of life in patients after transurethral prostatectomy (TURP). Fifty-eight consecutive patients who were selected to undergo TURP for benign prostatic hyperplasia (BPH) were admitted into the study: 28 were randomly assigned to a control group (A), 30 formed the investigational group (B) during an initial visit conducted before surgery. In group B patients, perineal exercises were demonstrated in detail, and tested for their correct use via simultaneous rectal and abdominal examination. After the removal of the urethral catheter, these patients were instructed to perform pelvic floor muscle exercises at home and were evaluated before the exercises and at weekly intervals postoperatively. The American Urological Association Symptom Score improved significantly after TURP in both groups. The average quality of life score improved more significantly in group B after TURP, from 5.5 to 1.5 (P < 0.001). The grade of muscle contraction strength after 4 weeks of PME increased from 2.8 to 3.8 in group B (P < 0.01); it was unchanged in the group A. The number of patients with incontinence episodes and post-micturition dribbling was significantly lower in the group B at weeks 1, 2, and 3 (P < 0.01). Our results show that pelvic floor muscle re-education produces a quicker improvement of urinary symptoms and of quality of life in patients after TURP. Its early practice reduces urinary incontinence and post-micturition dribbling in the first postoperative weeks. The exercises are simple and easy to perform in the clinical setting and at home, and therefore should be recommended to all cooperative patients after TURP.
Neurourology and Urodynamics, 1994
Urc~lynamic investigation wa\ pcrlormcd in I 2 men. 3 t o H months after cystoprostatectomy for h... more Urc~lynamic investigation wa\ pcrlormcd in I 2 men. 3 t o H months after cystoprostatectomy for hladdcr cancer and hladdcr whstitution. using a dctuhulariml ileal scgnient a\ described hy Studer-Zingg. All patients underwent a standard urodynamic evaluation and extramural amhulatory urtdynamic monitoring (c.a.111.). Ten patients were continent by day and 3 were incontinent during the night t o a degree that necessitated use o f a condom catheter. Three patient5 awakened every 3 hour\ t o void and h had t o void 1-2 times nightly. The residual urine w;is over I00 nil in 3 patients: it was low or absent in the rcniainder. Micturition was achicvcd by straining. with a maxiniuni flow rate of 13 nil pc" second or greater. cxccpt in 1 patients. I n 2 patient5 il urethral narrowing was found at the urethro-ileal ana\tonio\i\. and in I o f them an inctx)rdination bctwccn the ncohladdcr and the pelvic floor required the use of a urethral catheter and a subsequent protocol of pelvic floor rehahilitation. The incidence o f nocturnal incontinence was Sh.h%. I n 2 patients urethral prc\surc profile revealed hypotonia. with a maximum urethral closure pressure f MUCP) < 45 cni H,O. During c.;i.iii. \tudy pressure values i n the ncohladdcr u5ually ranged helow 15 ciii H , O and cxcccilcd 35 cni H,O in only I patient who complained ot daytime and ntwturnal incontinence. Ncohladdcr compliance was normal in a l l case\ In order to achieve a complete rchabilitatit)n after opcration. the patient \hould hc instructed t o I'ollow a careful training in order t o prevent overdistention ol the ncohladdcr by voiding at regular Intervals and t o obtain continence.
The Journal of Urology, 1999
Interstitial cystitis is a chronic benign disease of the bladder that causes bothersome and debil... more Interstitial cystitis is a chronic benign disease of the bladder that causes bothersome and debilitating symptoms and mainly affects women. Since interstitial cystitis (IC) might result from a defective glycosaminoglycan layer of the bladder epithelium, we conducted a trial of hyaluronic acid (HA), used intravesically, to test its activity in the treatment of this disease. A total of 10 patients with typical findings of IC were included. Following bladder catheterisation, the patients received a dose of 40 mg, weekly for 6 weeks, and then monthly. Response to therapy was evaluated by comparing the pre-treatment and post-treatment symptom scores and voiding diaries. There was a 30% positive response rate at week 6, which was maintained until week 24. No significant local or general side-effects were noted during the course of treatment. Although we recorded a low incidence of success in our group of patients, the results of our limited study were satisfactory in the group of responsive patients (30%), who had no relapses during the observation period of 6 months. The intravesical administration of HA was well tolerated in all cases.
Journal of Urology, 1998
UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPIC SURGERY monohydrate crystals but that when the calcium... more UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPIC SURGERY monohydrate crystals but that when the calcium oxalate crystals attach to rend tubular cells they may induce the cell to form uropontin. Interestingly, the messenger ribonucleic acid responsible for the production of uropontin may be most highly concentrated in the cells of the distal collecting tubule and caliceal fornices. Yoshimura et al explore the role of glycosaminoglycans in calcium oxalate crystal growth. Heparan sulfate and dermatan sulfate seem to be the primary glycosaminoglycans responsible for inhibiting calcium oxalate crystal growth. Controversy continues as to whether Tamm-Horsfall proteins truly inhibit or pomibly promote stone formation. The current consensus favors an inhibitory response through the disruption of calcium oxalate crystal aggregation. Romero et al were successful in developing BP enzymelinked immunosorbent assay from rabbit antiserum to total hydroxyproline. They were able to show a markedly decreased level of total hydmxyproline in patients with urolithiasis. Overall, the area of research regarding stone formation inhibition is quite active. These studies may well form the foundation for the development of more effective therapy to prevent recurrent urolithiasis.
The Journal of Sexual Medicine, 2011
Introduction. Dyspareunia and sexual dysfunction are common in women with urological disorders. T... more Introduction. Dyspareunia and sexual dysfunction are common in women with urological disorders. The study of comorbidity between interstitial cystitis (IC) and vulvodynia seems to be relevant to understand the mechanism generating pain in these conditions. Aim. To conduct a case-control study for evaluating vulvodynia and sexual dysfunction in women with IC. Methods. Forty-seven women with new diagnosis (National Institutes of Health [NIH]/National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] Criteria) of IC were compared with 188 age-matched, negative controls. Each woman completed a semi-structured interview and the Female Sexual Function Index (FSFI). A gynecological examination to assess vulvodynia (cotton swab testing) and genital health (vulvoscopy, Pap smear, culture, and vaginal health index score [VHIS]) was performed. Main Outcome Measures. Prevalence of vulvodynia, sexual function, and sociodemographic/gynecological variables significantly associated with IC. Results. Spontaneous or provoked vulvodynia was reported by 23.4% and 74.5% of IC cases, respectively. Sexual function was significantly impaired (median total FSFI score: IC cases 16.85 Ϯ 8.73 vs. controls 27.34 Ϯ 6.41; P < 0.0001) in sexually active women, and 23.4% of IC cases as compared to 9% of controls reported no sexual activity in the year preceding the study (c 2 for trend = 38.2, P < 0.0001). VHIS was highly impaired in women with IC in comparison with controls (P < 0.0001). Variables significantly associated with IC were a diagnosis of menopause (odds ratio [OR] = 31.2, 95% confidence interval [CI] = 8.1-120.5), past (OR = 4.6, 95% CI = 1.74-12.1) or current (OR = 6.9, 95% CI = 2.1-22.1) oral contraceptive use, and a histologically confirmed diagnosis of endometriosis (OR = 3.7, 95% CI = 1.1-12.7). Conclusion. We found an increased prevalence of vulvodynia among women with recently diagnosed IC; both conditions seem to have profound consequences on women's sexual function. A potential role for sex hormonedependent mechanisms into the comorbidity of vulvar and bladder pain is proposed, but further research is warranted. Gardella B, Porru D, Nappi RE, Daccò MD, Chiesa A, and Spinillo A. Interstitial cystitis is associated with vulvodynia and sexual dysfunction-A case control study.
Carissimi Colleghi e Soci, grazie alle fatiche della Commissione, coordinata splendidamente da Ro... more Carissimi Colleghi e Soci, grazie alle fatiche della Commissione, coordinata splendidamente da Roberto Migliari, e dell'editore Alberto Mandressi, e grazie alla collaborazione generosa dell'Alfa Wassermann, ho il piacere di presentarVI una nuova AUROLINE. Cimentarsi con i disturbi urinari nella donna era un compito titanico tipico delle imprese della nostra Associazione, sia per la complessità dell'argomento sia per la "fisiologica" multidisciplinarietà. Essere riusciti nell'impresa in un solo anno non è cosa da poco e conferma ancora una volta che l'AURO.it parla principalmente coi fatti. Ormai da anni produciamo una linea guida all'anno, con impressionante regolarità, linne guida che costituiscono un prezioso strumento di lavoro per moltissimi urologi italiani. Il prossimo impegno sarà la linea guida sui LUTS e sull'IPB e nel frattempo inizieremo l'opera di aggiornamento delle prime linee guida. Sappiamo che qualcuno preferirebbe un' Associazione con più parole, più complotti, più ricatti, più cose insomma di cui parlare nei corridoi sorseggiando un caffè, ma che volete farci, noi siamo fatti così....
The prevalence of interstitial cystitis/painful bladder syndrome (IC/PBS) among gynecologic patie... more The prevalence of interstitial cystitis/painful bladder syndrome (IC/PBS) among gynecologic patients attending vulvar disease or pelvic pain clinics is higher than expected. The evaluation of gynaecologic charateristics in patients with IC/PBS could be important to delineate a better therapeutic strategy. We compared clinical gynecologic characteristic including localized and generalized vulvodynia and sexual activity of 47 women with a definite diagnosis of IC/PBS versus 47 negative controls. The prevalence of both generalized or localized vulvodynia was 85.1% in the patients and 6.4% in the control group. The mean visual analogue score on generalized or loclaized vulvodynia evaluated with the Cotton-swab test was 6.1+2.6 among women with IC/PBS and 0.6+1.7 in the control group. Pain during intercourse was described as unbearable by 15 women with IC/PBS and 2 controls. Sexual function was significantly impaired in women with IC as measured by the median total score of the Female Se...
European Urology, 1996
We analyzed preoperative and postoperative urodynamic parameters in 26 patients who underwent tra... more We analyzed preoperative and postoperative urodynamic parameters in 26 patients who underwent transurethral prostatic resection with the aid of a computer program. The parameters URA, W and Wmax were evaluated: URA affords a monitoring of the removal of obstruction, while Wmax and W function monitor changes in detrusor contractility, which appear significant after prostatic resection in obstructed patients. Many patients had a fading contraction, that is detrusor contractility decreased during micturition: in most of them the removal of obstruction restored this pattern to normal. Evaluation of these parameters is recommended for preoperative assessment and postoperative follow-up.
European Urology, 1997
We report on a 50-year-old woman first treated by us in 1990 for uroseptic fever. Urography showe... more We report on a 50-year-old woman first treated by us in 1990 for uroseptic fever. Urography showed occlusion of the terminal tract of the lower third of the left ureter. The patient was submitted to successful left ureteroneocystostomy (UNCS). Three months later, she had a relapse of uroseptic fever, and urography showed right ingravescent dilation and excellent functional activity of the left urinary tract. Right UNCS was performed. A further relapse on the right side was again treated with UNCS and psoas-hitch bladder, but both the dilation and the occlusion persisted. Considering the state of the patient, and in order to remove the right nephrostomy that had been applied in the meantime, and to reduce the state of inflammation in view of further surgery, it was decided to treat the right ureteral total stenosis with ureteroscopic resection through the ureter facilitated by an other luminous flexible ureteroscope inserted upstream via nephrostomy. This technique is based on concepts searching for stenotic ureteral zones in transplanted kidneys, with the help of an adequate luminous catheter. An X-ray follow-up 9 months later evidenced that the maneuver was totally successful.
European Urology, 1997
Different etiopathological mechanisms of enuresis are today under study, and different therapies ... more Different etiopathological mechanisms of enuresis are today under study, and different therapies and drugs have been proposed. The Italian Multicentric Trial was undertaken in twelve pediatric and urological centers in order to assess the efficacy of two of the most popular drugs, desmopressin (DDAVP) and oxybutynin. 114 enuretic patients were enrolled in the study. After a 2-week observation period, 66 patients with primary monosymptomatic enuresis were treated with DDAVP, 30 micrograms/day intranasally, for 6 weeks, 48 patients with enuresis and voiding dysfunction were randomly assigned to a protocol with oxybutynin alone or oxybutynin plus DDAVP. The efficacy of the two drugs was measured in terms of reduction of wet nights per week during the 6-week treatment period and a 2-week follow-up period. Children with 0-3 dry nights/week were considered as nonresponders. Patients with monosymptomatic enuresis treated with DDAVP reported a significantly lower number of wet night during treatment than during the baseline period, with 79% showing a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;good&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (6-7 dry nights/week) or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;intermediate&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; response (4-5 dry nights/week). Of the patients with diurnal voiding disturbances and enuresis, those treated with oxybutynin alone had a 54% success rate. The patients treated with both oxybutynin and DDAVP showed a better response, with a 71% rate of success. The efficacy of the two drugs is confirmed in patients carefully selected on the clinical basis of voiding disturbances. In patients with enuresis and voiding dysfunction, the reduced urinary output and the lower bladder filling rate due to DDAVP can reduce uninhibited bladder contractions, thus enhancing the oxybutynin action.
European journal of physical and rehabilitation medicine, Oct 12, 2016
Pain represents a common problem in the setting of neurorehabilitation, in that it is a common ou... more Pain represents a common problem in the setting of neurorehabilitation, in that it is a common outcome measure but may also have a negative effect on motor and cognitive outcomes. Guidelines, expert opinions or consensus statements on pain in neurorehabilitation are largely lacking. The Italian Consensus Conference on Pain in Neurorehabilitation (ICCPN) was promoted to answer some questions on this topic, and its recommendations may offer practical and useful information and represent the basis for future studies on pain in neurorehabilitation.
Archivos españoles de urología, 1998
The aim of our study was to analyze the effect of gynecological dysfunction on voiding symptoms i... more The aim of our study was to analyze the effect of gynecological dysfunction on voiding symptoms in women. A modified AUA symptom index questionnaire was self-administered and an ambulatory home uroflowmetry was performed, using a specially designed home uroflowmetry apparatus for multiple flow measurements. Urinary symptoms and home uroflowmetry (Home Urodata TM System) were evaluated in 68 women: 34 patients with gynecological dysfunction, and 34 normal controls. A total of 156 urination episodes was recorded, with a mean of 5.4 measurements per patient. Symptom index showed lower values in the group of normal controls than in the group with gynecological dysfunction. Voided volume, peak flow rate and average flow rate were all significantly better in the group of normal controls than in the group with gynecological disorders; the most remarkable changes were observed in patients with genital prolapse and with large uterine fibroma. In both groups the total urine volume was lower b...
Annales d'urologie, 1999
This article examines the technical modalities or ureteral catheterization. The authors also disc... more This article examines the technical modalities or ureteral catheterization. The authors also discuss unconventional modalities which, if used without prejudice, can sometimes constitute brilliant and economic solutions to complex problems which are often impossible to resolve otherwise. After a summary of the history of ureteral catheterization, the authors present the main indications for temporary ureteral catheterization: radiographic and fluoroscopic examination of the ureter; separate cytological harvesting; separate bacteriological harvesting; confirmation of the side of unilateral haematuria; preliminary temporary dilatation of the ureter to prepare it for ureteroscopy; temporary drainage of the excretory tract after endourological investigation. The authors also present particular situations may be observed temporary catheterization, or even permanent stenting, for example in the case of procedures in children, pregnant women and renal transplant recipients.
European Urology Supplements, 2008
Objectives- The aim of our study was to test the effect of a more viscous compound than existent ... more Objectives- The aim of our study was to test the effect of a more viscous compound than existent hyaluronic acid formulation in helping to restore a defective glycosaminoglycan layer, and therefore in improving Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) symptoms when administered intravesically in IC/PBS patients. Methods- A total of 23 female patients completed the study. Patients received endovesical administration of hyaluronic acid and chondroitin sulfate in normal saline, 40 ml, weekly for 12 weeks and then bi-weekly for 6 months, if there was initial response. Results- After 12 weeks treatment both Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), pelvic pain and Urgency/Frequency Symptom Scale (PUF) showed a mean significant improvement, which was maintained thereafter. The average number of voidings and mean voiding volumes revealed significant improvement after the 12 weeks treatment period, with a significant reduction and increase, respectively. Mean voiding volume increased from 143 ml to 191, which apparently was not reflected in a corresponding reduction of number of daily voids (from 15,5 to 14). VAS values decreased from 5,4 to 3,6 (pain) and from 6,0 to 3,5 (urgency) after the treatment cycle, showing a significant improvement. Conclusions- In our preliminary experience, the administration of intravesical hyaluronic acid plus chondroitine sulphate appears to be a safe and efficacious method of treatment in IC/PBS.
European Urology Supplements, 2008
Journal of Pharmaceutics, 2013
Bladder pain is a characteristic disorder of interstitial cystitis. Diazepam is well known for it... more Bladder pain is a characteristic disorder of interstitial cystitis. Diazepam is well known for its antispasmodic activity in the treatment of muscular hypertonus. The aim of this work was to develop and characterize vaginal pessaries as an intravaginal delivery system of diazepam for the treatment of interstitial cystitis. In particular, the performance of two types of formulations, with and without beta-glucan, was compared. In particular, the preparation of pessaries, according to the modified Pharmacopeia protocol, the setup of the analytical method to determine diazepam, pH evaluation, dissolution profile, and photostability assay were reported. Results showed that the modified protocol permitted obtaining optimal vaginal pessaries, without air bubbles, with good consistency and handling and with good pH profiles. In order to determine the diazepam amount, calibration curves with good correlation coefficients were obtained, by the spectrophotometric method, using placebo pessari...
Urologia Internationalis, 1994
The study included 18 men, submitted to urodynamic investigation 9-18 months after cystoprostatec... more The study included 18 men, submitted to urodynamic investigation 9-18 months after cystoprostatectomy for bladder cancer and bladder substitution with a detubularized ileal segment as described by Studer-Zingg. Sixteen patients were continent by day and 3 were incontinent during the night so as to require the use of a condom catheter. The residual urine was over 100 ml in 3 patients, while it was low or absent in the remainder. Micturition was performed by straining, and maximal flow rates were normal, although the pattern was intermittent. The incidence of nocturnal incontinence was 55.5%. Measurement of the urethral pressure profile revealed a shortened functional length, and low pressure was found in 3 patients, with a maximum urethral closure pressure < 45 cm H2O. During extramural ambulatory urodynamic monitoring, pressure values in the neobladder usually ranged below 20 cm H2O and exceeded 34 cm H2O in only 2 patients who complained of daytime and nocturnal incontinence. The urodynamic features of the neobladder in patients who underwent radical cystoprostatectomy and bladder replacement with a detubularized ileal segment indicate low pressure at high-level filling.
Spinal Cord, 1996
We report on a 16-year old patient with a neuropathic bladder secondary to Behcet's disease, whic... more We report on a 16-year old patient with a neuropathic bladder secondary to Behcet's disease, which is an uncommon vasculitis usually involving venules. The genitourinary manifestations of this disease are discussed, a neuropathic bladder being a rare complication of the involvement of the nervous system. Urodynamic assessment is important when voiding dysfunction is present; three patients previously reported revealed a bladder function changing from normal detrusor to overactivity. Our patient showed early and severe involvement of the nervous system, and detrusor areflexia two years after the onset of the disease. Spontaneous voiding was restored two months after urological management (intermittent catheterization) was started.
Prostate Cancer and Prostatic Diseases, 2005
A group of 107 patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargemen... more A group of 107 patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE) participated to the HOUSE Study (Home and Office Uroflowmetry Specific Evaluation). Patients received routine investigation, consisting of medical history taking, physical examination including digital rectal examination, prostate-specific antigen (PSA), assessment of symptoms listed both on the International Prostate Symptom Score and on ICS-male questionnaire. We examined the results of uroflowmetry evaluation in this population; data were analysed to observe if any circadian changes of parameters obtained with home uroflowmetry could be detected. We searched a correlation between Q max , Q ave and ICS-benign prostatic hyperplasia symptom score: a significantly inverse correlation was found only for Q max , confirming Q max as a reliable parameter to quantify subjective symptoms. When examining the multiple flow curves recorded in the same patient with home uroflowmetry, voided volume and flow time had usually higher values during night-time: the existence of circadian changes of uroflowmetry parameters in patients with LUTS from BPE was confirmed, and lower values of average and maximum flow rates during sleep hours were recorded in the same patient. In conclusion, when evaluating the natural history or treatment outcome of individual patients or group of patients in clinical trials for evaluation of BPE and LUTS, an assessment including multiple measurements may be useful and of value.
Neurourology and Urodynamics, 2000
We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters... more We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters, urinary incontinence, post-micturition dribbling, and quality of life in patients after transurethral prostatectomy (TURP). Fifty-eight consecutive patients who were selected to undergo TURP for benign prostatic hyperplasia (BPH) were admitted into the study: 28 were randomly assigned to a control group (A), 30 formed the investigational group (B) during an initial visit conducted before surgery. In group B patients, perineal exercises were demonstrated in detail, and tested for their correct use via simultaneous rectal and abdominal examination. After the removal of the urethral catheter, these patients were instructed to perform pelvic floor muscle exercises at home and were evaluated before the exercises and at weekly intervals postoperatively. The American Urological Association Symptom Score improved significantly after TURP in both groups. The average quality of life score improved more significantly in group B after TURP, from 5.5 to 1.5 (P < 0.001). The grade of muscle contraction strength after 4 weeks of PME increased from 2.8 to 3.8 in group B (P < 0.01); it was unchanged in the group A. The number of patients with incontinence episodes and post-micturition dribbling was significantly lower in the group B at weeks 1, 2, and 3 (P < 0.01). Our results show that pelvic floor muscle re-education produces a quicker improvement of urinary symptoms and of quality of life in patients after TURP. Its early practice reduces urinary incontinence and post-micturition dribbling in the first postoperative weeks. The exercises are simple and easy to perform in the clinical setting and at home, and therefore should be recommended to all cooperative patients after TURP.
Neurourology and Urodynamics, 1994
Urc~lynamic investigation wa\ pcrlormcd in I 2 men. 3 t o H months after cystoprostatectomy for h... more Urc~lynamic investigation wa\ pcrlormcd in I 2 men. 3 t o H months after cystoprostatectomy for hladdcr cancer and hladdcr whstitution. using a dctuhulariml ileal scgnient a\ described hy Studer-Zingg. All patients underwent a standard urodynamic evaluation and extramural amhulatory urtdynamic monitoring (c.a.111.). Ten patients were continent by day and 3 were incontinent during the night t o a degree that necessitated use o f a condom catheter. Three patient5 awakened every 3 hour\ t o void and h had t o void 1-2 times nightly. The residual urine w;is over I00 nil in 3 patients: it was low or absent in the rcniainder. Micturition was achicvcd by straining. with a maxiniuni flow rate of 13 nil pc" second or greater. cxccpt in 1 patients. I n 2 patient5 il urethral narrowing was found at the urethro-ileal ana\tonio\i\. and in I o f them an inctx)rdination bctwccn the ncohladdcr and the pelvic floor required the use of a urethral catheter and a subsequent protocol of pelvic floor rehahilitation. The incidence o f nocturnal incontinence was Sh.h%. I n 2 patients urethral prc\surc profile revealed hypotonia. with a maximum urethral closure pressure f MUCP) < 45 cni H,O. During c.;i.iii. \tudy pressure values i n the ncohladdcr u5ually ranged helow 15 ciii H , O and cxcccilcd 35 cni H,O in only I patient who complained ot daytime and ntwturnal incontinence. Ncohladdcr compliance was normal in a l l case\ In order to achieve a complete rchabilitatit)n after opcration. the patient \hould hc instructed t o I'ollow a careful training in order t o prevent overdistention ol the ncohladdcr by voiding at regular Intervals and t o obtain continence.
The Journal of Urology, 1999
Interstitial cystitis is a chronic benign disease of the bladder that causes bothersome and debil... more Interstitial cystitis is a chronic benign disease of the bladder that causes bothersome and debilitating symptoms and mainly affects women. Since interstitial cystitis (IC) might result from a defective glycosaminoglycan layer of the bladder epithelium, we conducted a trial of hyaluronic acid (HA), used intravesically, to test its activity in the treatment of this disease. A total of 10 patients with typical findings of IC were included. Following bladder catheterisation, the patients received a dose of 40 mg, weekly for 6 weeks, and then monthly. Response to therapy was evaluated by comparing the pre-treatment and post-treatment symptom scores and voiding diaries. There was a 30% positive response rate at week 6, which was maintained until week 24. No significant local or general side-effects were noted during the course of treatment. Although we recorded a low incidence of success in our group of patients, the results of our limited study were satisfactory in the group of responsive patients (30%), who had no relapses during the observation period of 6 months. The intravesical administration of HA was well tolerated in all cases.
Journal of Urology, 1998
UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPIC SURGERY monohydrate crystals but that when the calcium... more UROLITHIASIS, ENDOUROLOGY AND LAPAROSCOPIC SURGERY monohydrate crystals but that when the calcium oxalate crystals attach to rend tubular cells they may induce the cell to form uropontin. Interestingly, the messenger ribonucleic acid responsible for the production of uropontin may be most highly concentrated in the cells of the distal collecting tubule and caliceal fornices. Yoshimura et al explore the role of glycosaminoglycans in calcium oxalate crystal growth. Heparan sulfate and dermatan sulfate seem to be the primary glycosaminoglycans responsible for inhibiting calcium oxalate crystal growth. Controversy continues as to whether Tamm-Horsfall proteins truly inhibit or pomibly promote stone formation. The current consensus favors an inhibitory response through the disruption of calcium oxalate crystal aggregation. Romero et al were successful in developing BP enzymelinked immunosorbent assay from rabbit antiserum to total hydroxyproline. They were able to show a markedly decreased level of total hydmxyproline in patients with urolithiasis. Overall, the area of research regarding stone formation inhibition is quite active. These studies may well form the foundation for the development of more effective therapy to prevent recurrent urolithiasis.
The Journal of Sexual Medicine, 2011
Introduction. Dyspareunia and sexual dysfunction are common in women with urological disorders. T... more Introduction. Dyspareunia and sexual dysfunction are common in women with urological disorders. The study of comorbidity between interstitial cystitis (IC) and vulvodynia seems to be relevant to understand the mechanism generating pain in these conditions. Aim. To conduct a case-control study for evaluating vulvodynia and sexual dysfunction in women with IC. Methods. Forty-seven women with new diagnosis (National Institutes of Health [NIH]/National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] Criteria) of IC were compared with 188 age-matched, negative controls. Each woman completed a semi-structured interview and the Female Sexual Function Index (FSFI). A gynecological examination to assess vulvodynia (cotton swab testing) and genital health (vulvoscopy, Pap smear, culture, and vaginal health index score [VHIS]) was performed. Main Outcome Measures. Prevalence of vulvodynia, sexual function, and sociodemographic/gynecological variables significantly associated with IC. Results. Spontaneous or provoked vulvodynia was reported by 23.4% and 74.5% of IC cases, respectively. Sexual function was significantly impaired (median total FSFI score: IC cases 16.85 Ϯ 8.73 vs. controls 27.34 Ϯ 6.41; P < 0.0001) in sexually active women, and 23.4% of IC cases as compared to 9% of controls reported no sexual activity in the year preceding the study (c 2 for trend = 38.2, P < 0.0001). VHIS was highly impaired in women with IC in comparison with controls (P < 0.0001). Variables significantly associated with IC were a diagnosis of menopause (odds ratio [OR] = 31.2, 95% confidence interval [CI] = 8.1-120.5), past (OR = 4.6, 95% CI = 1.74-12.1) or current (OR = 6.9, 95% CI = 2.1-22.1) oral contraceptive use, and a histologically confirmed diagnosis of endometriosis (OR = 3.7, 95% CI = 1.1-12.7). Conclusion. We found an increased prevalence of vulvodynia among women with recently diagnosed IC; both conditions seem to have profound consequences on women's sexual function. A potential role for sex hormonedependent mechanisms into the comorbidity of vulvar and bladder pain is proposed, but further research is warranted. Gardella B, Porru D, Nappi RE, Daccò MD, Chiesa A, and Spinillo A. Interstitial cystitis is associated with vulvodynia and sexual dysfunction-A case control study.