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We refer herein on a simple program of rehabilitation that may be a first approach the treatment of, U.S.I. In our urodynamic service, we treated 38 female patients, affected by this condition, aged between 37-73 years. The same procedure was applied to all the patients, consisting of 10 seances twice weekly, during which we subjected the patients to biofeedback and vaginal electrostimulation of 50 Hz frequency. The results after 3 months were: 38% restored to normal, 51% improved, 11% unchanged; after 1 year were: 27% restored to normal, 49% improved, the remaining unchanged. As a whole, perineal rehabilitation by this technique can be curative in selected cases and, should it be necessary, can be repeated; its advantages are simplicity, low cost and lack of collateral effects. Motivation and compliance on the part of the patients are, anyhow, the chief factor of success. Moreover, the procedure does not preclude alternative treatments. It is suitable to chose cases where surgery is not so, or else is ill-accepted or has failed.

Vesico-vaginal fistula (VVF) is still an unpleasant complication of female genital system surgery. We report the case of a 57-years-old woman undergone to neoadjuvant radiotherapy and afterwards abdomino-perineal resection who developed after one months a VVF.

Purpose: To evaluate the efficacy of early enteral nutrition in management of patients operated by major urologic surgery and to demonstrate her advantages versus total parenteral nutrition., Materials and Methods: 20 patients, operated by radical cystectomy and urinary diversion by ureteroileocutaneostomy, Padua ileal bladder or ureterosigmoidostomy are inserted in our study: 12 were treated by early enteral nutrition for 8 days and eight by total parenteral nutrition for the same period: in each group nutritional and immunological parameters at day -1, +3 and +7, the length of postoperatory stay, the incidence of complications, with particular respect for infections have been evaluated and correlated one to each other., Results: We have no death in each group; in the first group no gastroenteric allergy to the nutrient, less incidence of venous catheter and surgical wound infections (respectively p < 0.01 and p < 0.005); we have no significant decrease of postoperatory stay length; the effective problem in this group was the incidence of diarrhea, that in one case have made necessary the suspension of enteral nutrition. Enteral nutrition costs were about half of those of total parenteral nutrition., Conclusions: We believe that early enteral nutrition is an effective and safe nutrition method in patients operated by major urologic surgery: with this is possible a better nutrition, that reduce the incidence of postoperative complications, mainly infections, and maybe the length of postoperatory stay (our champion is too small for statistical evaluation), that may lead to a decrease in management costs of these patients.

From February 1996 to March 1997, we have performed with the Vesica system the percutaneous bladder neck suspension in 13 pts (group 1) and the vaginal wall sling in 7 pts (group 2). After a mean follow-up of 12 months for group 1, 10 patients (76.9%) were "dry", 1 pt "improved" and 2 "failed"; in the group 2 (mean follow-up of 5 months) 6 pts/7 were "dry". Overall morbidity has been minimal. The percutaneous bladder neck suspension and the vaginal wall sling with Vesica system are minimally invasive surgical procedures for the urinary stress incontinence (hypermobility of bladder outlet and intrinsic sphincter deficiency).

Since the 1993, a series of 22 women with stress urinary incontinence underwent bladder neck suspension, according to Gittes (pubovaginal suspension). No patients had preoperative detrusor instability or intrinsic sphincter dysfunction; 14 pts had a significant cystocele (II-III degree). We followed up 20 pts at 6 months: 9 pts (45%) were cured, 3 were significantly improved and 8 were not improved. Disappearance or marked improvement of moderate or severe cystocele wasn't confirmed in all pts. No serious complications were recognized. We believe that this procedure is quick and easy to perform with low morbidity and is useful where the indication is correct: patients with stress incontinence without significant anterior vaginal wall prolapse.

Fibroangiomatous polyps and its histological variants most often occur in the ureters of young adult. They may be multiple, and rarely occur in the renal pelvis. Microscopically, normal or hyperplastic urothelium cover loose, vascular, edematous, fibrous stroma that may be inflamed. Etiologic factors are unknown. Intermittent flank pain is the most common symptom; dysuria and hematuria occur less frequently. A case of fibroangiomatous polyps of the left ureter, in a 37-years old woman, is presented. We emphasize the endoscopic conservative treatment of this lesion as a valid alternative to the surgical approach; beside, it's important to obtain pre-operative histological finding, confirming the benign lesion.

Dynamic and static factors cause infravesical obstruction in men with BPH. The dynamic component is determined by alpha 1-adrenoceptor-mediated contractions of the prostate smooth muscle and bladder neck. Using alpha-receptor-blockers will relieve bladder outlet obstruction, improving urinary flow rates and obstructive and irritative symptoms as well as the physician's global assessment. This study was performed to evaluate the efficacy and safety of alpha 1 blockers (terazosin and alfuzosin) in ambulatory patients (n = 20) with BPH. After 24 weeks of therapy, the peak flow rate increased 54% from a baseline average of 8.5 ml/s to 13.1 ml/s (p < 0.01). The mean flow rate increased 49%, from a baseline of 4.61 ml/s to 6.9 ml/s (p < 0.01); residual volume decreased 74% from 48.3 ml to 12.5 ml (p < 0.001). Mean systolic blood pressure decreased significantly (p < 0.05) from baseline, but this change wasn't clinically important. The clinical experience with alpha-blockers in BPH indicates that these drugs increase urinary flow rates, decrease obstructive and irritative symptoms, without serious side effects.

In urology, the use of angiographic wires (glidewires) allows the anterograde, retrograde and "mixed" approach in obstructive and not obstructive uropathies stenting. The Authors reported a case of oligoanuria in a patient with progressing prostatic cancer resolved with endoscopical recanalization and secondary indwelling double-J ureteral stenting.

Uroflowmetry is the most physiologic and non invasive assessing method of lower urinary tract obstruction: it proves to bring objective evidence of the prostatic blockage degree. We performed 1094 urinary flow tests in 264 patients with BPH, suffering from voiding problems; 188 males had undergone surgical treatment and 86 medical therapy. These patients were examined again about 3 months after prostatectomy and about 3, 6, 9 months during pharmacologic treatment. Symptoms were valued according to international prostatic symptomatologic score (I-PSS). The assessment of residual urine was performed by bladder ultrasound. Among the 264 patients, nocturia was present in 81.8%, weakness of stream in 75% and urgency in 47.7%. The average I-PSS for obstructed patients and postoperative were respectively 26 (21-32) and 5 (0-7). Frequency and weakness of stream were commonly (80% of cases) associated with a reduction in the maximum flow rate (Qmax). Qmax and average flow (Qave) improved after prostatectomy respectively from 7.1 ml/s to 18.9 ml/s and 4.1 ml/s to 8.3 ml/s. 6/264 males with normal Qmax and 132/264 with Qmax < 10 ml/s were shown to have residual urine > 80 ml. Among the uroflowmetry parameters analysed, the best correlation with the degree of prostatic obstruction degree is Qmax. Residual urine is a sign of an abnormality of bladder function rather than the direct result of urethral blockage. Uroflowmetry is a useful clinical tool in the diagnosis and follow-up of males with BPH.

The rules for a diagnostic approach to non-acute prostatitis, as applied during a one-year trial in this Division of Urology, are reviewed and their results on a clinical ground of 150 cases are discussed. In fact, this clinical conditions is apt to present often some problems, as far its cure is concerned, due to its variety of symptoms, and not seldom to un-correct previous therapeutic approach, for defect of a precise diagnostic appraisal.

Repetitive surgery on the upper urinary tract calls for extensive and sometimes difficult dissection, therapy exposes to the risk of vascular and nervous injury, as far as tissue trophism is concerned, moreover to secondary severe perivisceral fibrosis. The ureter is particularly liable to such early or late damages. The use of a self-retaining stent, even for a long period of time, and of a pedicle omental graft wrapping ensures a better recovery and the prevention of fistulae or strictures from secondary retroperitoneal fibrosis.

On the ground of the clinical experience of transurethral resection of the benign hypertrophy of the prostate performed in the Division of Urology during the last ten years, the technical aspects and problems of the procedure are discussed, chiefly the low-pressure irrigation of the operative field for the prevention of vesical damages and of the water-syndrome. The choice of the transurethral technique is dependent chiefly on the weight of the adenoma, on the duration of its removal and the related problems; it is also dependent on the availability of both proper instrumentation and operators. The lesser all-over surgical traumatism and blood loss, the precocious getting out of bed, the shortening of hospitalisation make T.U.R. particularly suitable for high risk patients. To conclude with, the clinical, personal and social advantages of this procedure depend on the correctness of its choice following the criteria which have been referred to.

A case is presented of uretero-vaginal fistula following hysterectomy for multiple fibromatosis. Duplicity of the left urinary tract, with caudal ectopy of ureteral opening of the branch draining the upper renal pole, could explain "a posteriori" some singularities of the clinical behaviour, i.e. combination of both controlled micturitions and continuous urinary loss "per vaginam" with seemingly normal urography. Postoperative chromocystoscopy afforded the correct diagnosis and surgical repair was followed by uneventful recovery. Preoperative assessment by urography and cystoscopy is therefore recommended prior to undertaking pelvic surgery, in order to promptly recognise complications to urinary tract, should they occur.

By real-time ultrasounds through an intra-vesical probe, bladder mucosal features, wall thickness and external profile, as well as their pathological changes, are beautifully imaged; therefore, the role of this echographic technique in the clinical pre-treatment assessment of tumor local staging is expected to be accurate and reliable, accordingly to the first results by Holms and co-w. We have intended to verify the value of the method, by comparing the pre-treatment staging by the more traditional non-invasive clinical procedures plus intra-vesical sonography to the pathological staging (pT) from the removed tumor samples. Our preliminary results are herein presented, from which the overall accuracy of this staging approach seems to be confirmed and a wider experimentation to be justified.