Urologia Journal

Urinary incontinence after radical prostatectomy presents different clinical features. We propose to clarify the etiology and the therapeutic approaches.

51 patients with urinary incontinence after radical prostatectomy underwent urodynamics, perineal EMG, perineal EMG frequency analysis and study of computerized sensory pudendal somatosensory evoked potentials.

18 patients (35%) were suffering from urinary incontinence secondary to overactive bladder, 14 patients (28%) had both an overactive bladder and a sphincter failure associated with Wallerian degenerative axonal neuropathy or segmental demyelination, 3 patients (6%) showed no significant urodynamics alterations but had signs of an incompetent sphincter neurapraxia, while 16 patients (31%) had urinary incontinence secondary to a degenerative neuropathy.

Urinary incontinence after radical prostatectomy shows an etiologic diversification and therefore requires different therapeutic approaches.

Even if Brachytherapy (BT) in low-risk prostate cancer (CaP) is a common practice since more than 20 and 10 years in USA and Italy, respectively, it is still an uncommon procedure because of the problems related to the organization and collaboration among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique.

Between May 1999 and September 2010, 250 patients with low risk CaP underwent l¹²⁵BT using a “real time” approach; the seeds implantation was performed using Mick applicator, in the first 190 patients, and the “Quick-Link” technique in the last 60 cases.

Oncologic results were reported in the first 150 cases with a mean follow-up of 95 months, while functional outcomes and complications were assessed in all the patients at different time points with a mean follow-up of 65 months.

A good quality implantation was assessed in 88% of patients (D90 >140 Gy). Overall, a biochemical failure was assessed, in accordance with Phoenix criteria, in 10 patients (6.6%). Among these patients, the prostatic biopsy showed a CaP in 6/10 patients, who underwent retropubic radical prostatectomy (4 pts) and external RT (2 pts); only one patient developed a systemic progression with secondary bone lesions and died after 122 months and 36 months from BT and RRP, respectively. The 4/10 patients with negative biopsy were treated with total androgen blockade (2 pts) and with watchful waiting (2 pts). Regarding functional results, we assessed a moderate incidence of irritative disorders (70%) during the first six months and a good recovery of erectile function after one year from surgery (78.8%).

Brachytherapy in the low-grade risk prostatic cancer represents a good alternative to RRP with excellent functional and oncologic results.

Long tract urethral reconstruction still has no other resolution than two-stage techniques or graft and flap procedures, that are neither simple nor trouble-free. Tissue engineering simplifies this surgery using porcine acellular matrix, obtained from small intestine submucosa (SIS): thin but strong, ready for grafting, it is not immunogenic, being deprived of cells. It is a biological bridge for reconstruction, promoting the regeneration of surrounding tissue. We report our experience using SIS for urethroplasty.

After coronal or perineal-scrotal incision and penile degloving, the urethra is rotated of 180° and opened through the entire restricted tract. The graft is sutured dorsally and reinforced by the contact with the cavernous bodies to prevent pouching. From 1999 to 2005 we performed this grafting procedure in 36 men and 4 women. Afterwards, 16 more surgeries performed were with direct ventral graft procedure, without urethra isolation and rotation, with worthy simplification. RESULTS. A 10–year follow-up shows satisfactory urodynamic and subjective outcomes for both procedures, assessed by voiding urethrography, uroflowmetry International Prostate Symptom Score, and Quality of Life perception. At urethroscopy the graft appears completely homogeneous to the native tissue, as confirmed by the histological examination. The ventral direct graft represents the more consistent innovation: we did not observe pouching and the results remained effective. For penile urethra, in a few patients, periodic dilatations were necessary.

SIS can be considered as an alternative to more difficult grafting procedures, which are probably no more indispensable in urethral enlargement, even for critical strictures.

The aim of this study was to translate and validate in Italian the condition-specific patient-reported outcome measure for urethral stricture surgery (PROM-USS-Q) and evaluate its psychometric properties to determine whether it was suitable for routine use.

We translated the English version; 52 men scheduled for bulbar urethroplasty at our high volume center agreed to self-complete PROM-USS-Q pre-operatively and between four and six months post-operatively We undertook an in-depth psychometric assessment of the questionnaire constructs.

There was excellent correlation between change in voiding symptom score and change in Qmax (p=0.746) with parallel improvements in EQ-5D visual analogue and time trade-off scores demonstrating criterion validity. Test-retest reliability and internal consistency statistics were similarly robust: intra-class correlation coefficients ranged from 0.81 to 0.90 for the individual voiding questions. Cronbach's alpha was 0.79 for the overall score and ranged between 0.74 and 0.81. These indices exceeded our predefined reliability thresholds for inclusion. Statistically highly significant improvements in construct scores occurred following urethroplasty, demonstrating responsiveness to change.

The PROM-USS-Q is a practical and robust instrument for assessing voiding symptoms and health-related quality of life following urethral stricture surgery.

The process of organizing a ultrasound service nowadays can be improved by properly managing the user's request, the speed of response and safety, the standardization of methods and skills.

The outpatients at our uro-andrologic ultrasound clinic (O.U. of Urology in Ferrara) received a questionnaire each; we administered a total of 640 questionnaires. The number of questionnaires collected was 532. Patients were asked to give an assessment of services using a qualitative method according to a 4-parameter response scale: very satisfied, satisfied, dissatisfied, very dissatisfied.

The identification of indicators to be monitored by the user's perceived quality was accomplished by establishing the correlation coefficient between different parameters of analysis and an overall rating of the sample. Some of these parameters were: the relationship with the practitioner, the availability of doctors, the ability of doctors for reassurance, the completeness of information and facilities hygiene conditions. When these parameters vary, positively or negatively, also the citizen's overall opinion changes.

The customer satisfaction is an important component of the quality of care, it represents both an indicator of the effectiveness of health intervention and the ability to meet quality requirements of the health service organization. The objective of an ultrasound service should be to provide, within a reasonable timeframe, the supply of high quality with qualified personnel, with adequate tools and procedures.

To study the killing effect of allitride on human renal cell carcinoma cell line Ketr-3 and its possible mechanisms.

The Ketr-3 cells were treated with allitride and the morphological changes were observed with inverted microscope. The cytotoxicity was estimated through theamine blue tetrazolium bromide (MTT). Apoptotic cells were detected by in situ cell apoptosis detection kit, and confirmed by flow cytometry. Changes of apoptosis rate cell cycle were assessed by flow cytometry. Caspase-3 (cysteine aspartate specific proteinase) mRNA was detected by semi-quantitative reverse transcriptase polymerase chain reaction (RT-PCR), and Caspase-3 protease activity was estimated with colorimetry

MTT assay and morphological changes confirmed the killing effect of allitride on Ketr-3 cell line. FCM also showed that S-phase and G2/M-phase arrest was induced. RT-PCR and colorimetry confirmed that there was apparently a rise of Caspase-3 mRNA and Caspase-3 protease activity.

Allitride could kill Ketr-3 effectively by inducing apoptosis. Cell cycle arrest and up-regulation of Caspase-3 may play an important role in the mechanisms of killing effect.