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INTRODUZIONE: Abbiamo pensato di effettuare uno studio che indagasse circa la presenza delle citochine nell’albuginea di soggetti affetti da malattia di La Peyronie. Le citochine, in quanto responsabili della comunicazione intercellulare, potrebbero essere coinvolte nella patogenesi della malattia. L’individuazione di una o più citochine responsabili potrebbe, infatti, risultare utile nel trattamento farmacologico grazie ai c.d. farmaci biologici, in grado di interferire con le citochine. MATERIALI E METODI: Per lo studio sono stati reclutati tra gennaio 2009 e dicembre 2010 presso l’Ambulatorio di Chirurgia Andrologica del Policlinico di Palermo 20 soggetti affetti da malattia di La Peyronie (fig. 1) e 8 soggetti affetti da recurvatum penis congenito, questi ultimi adoperati come controllo. Come criteri di inclusione allo studio abbiamo considerato i criteri di operabilità con corporoplastica secondo Nesbit. I prelievi bioptici ottenuti dalle losanghe escisse in corso di intervento chirurgico sono stati utilizzati per saggiare l’espressione genica, attraverso Real-Time PCR, di citochine pro-fibrotiche e pro-infiammatorie. Inoltre sono stati sottoposti dopo fissazione ad esame istologico con la colorazione ematossilina-eosina. RISULTATI E DISCUSSIONE: L’esame istologico ha rilevato l’assenza di cellule infiammatorie in tutti i pazienti recensiti per lo studio. L’analisi dell’espressione dei geni codificanti per IL-4 (Interleuchina-4), IL-6 (Interleuchina-6), IL-13 (Interleuchina-13), TGF-β1 (Trasforming Growth Factor - β1), IL-2 (Interleuchina-2), IL-10 (Interleuchina-10), TNF-α (Tumor Necrosis Factor- α) e IFN-γ (Interferone- γ) ha evidenziato in tutti i campioni un livello molto basso di trascritti e in alcuni casi indosabili (fig. 2). Inoltre i livelli dei trascritti delle citochine prese in esame sono risultati minori nei campioni provenienti dagli individui affetti da malattia di La Peyronie rispetto ai controlli. CONCLUSIONI: Alla luce dei risultati ottenuti, l’utilizzo di farmaci biologici (anticorpi) contro le citochine non sembra essere applicabile nella fase stabile della malattia di La Peyronie

Introduction & Objectives: The aim of our study was to compare and analyse the effectiveness of pharmacological treatment and the psychotherapy alone or in association in terms of increase of Quality of Life (QoL) measured through Premature Ejaculation Diagnostic Tool (PEDT) and increase of intravaginal eiaculation latency time (IELT) in patients affected by primitive premature ejaculation(PE). Material & Methods: Between January and December 2012, in our department underwent to medical examination 540 patients complaining PE. Criteria for enrollment were primitive PE with IELT ≤ 2 minutes, PEDT > 9 and absence of psychiatric disease, severe chronic disease, drugs and alcool abuse. Out of 540 patients, 270 were elegible and were enrolled for the study. This patients were randomly divided in 3 group, A,B and C. Patients in Group A were treated with Dapoxetine, mean age 49,8 years(range 20-68). Patients in Group B were treated with Dapoxetine in association with Psycological counselling and group therapy, mean age 49,2 years. Patients in Group C were treated with psycologycal counselling and group therapy alone, mean age 36,9(range 20-56). In the Group A and B was precribed Dapoxetine 30 mg 1 cps 1h before the intercourse with increase in dose to 60mg in case of ineffectiveness. In group B and C after a first psycological counselling one by one patients entered in group therapy with 20 weekly scheduled meetings. All patients were followed for 20 weeks, with 4 schedueld visit during this period. The PEDT was administred before treatment and one month after the end of the therapy. Data were recorded and analysed trought a multivariated analysis. Results: Out of 270 patients enrolled, 120 (44,4%) were compliant to therapy and weren’t evaluable. GROUP A. Out of 90 patients enrolled 60 were compliant to the study. Mean IELT pre-treatment 79,75 sec (range 15 sec–120 sec) and mean PEDT score 15,95 (severe PE). Mean IELT post-treatment 203 sec and mean PEDT 8,26 (moderate PE). Thirteen patients(21,6%) showed an improvement of clinical with mean PEDT score ≤ 8 and IELT ≥ 2 ( p ≤ 0,001). GROUP B. Out of 90 patients enrolled 60 completed the scheduled therapy. Mean IELT pre-treatment 74,83 sec (range 15 sec–120 sec) and mean PEDT score 16 (sever PE). Mean IELT post-treatment 600 sec and mean PEDT 3,3 (absence PE/ light PE) (p ≤ 0,001). In all patients of Group B was detected a reduction of PE. GROUP C. Out of 90 patients enrolled only 30 patients completed the scheduled therapy. Mean IELT pre-treatment 75 sec (range 15 sec–120 sec) and mean PEDT score 15,7. Mean IELT post-treatment 323 sec and mean PEDT 4,03(absence PE/ light PE). Fifteen patients (50%)showed a reduction of PE.All the results analyzed by multivariate analysis were statically significative. Conclusions: Comparing the result obtained in our three groups: in the Group B (Pharmacotherapy plus Psycotherapy) all patients showed an improvement of IELT and PEDT, while in the group A (only Pharmacotherapy)and C (only Psycotherapy) the percentage of patients that reported an improvement of IELT and PEDT were respectively 21,6% and 50%. Our study demonstrate that the psyclogical counselling have a significative role in the treatment of PE. In particulary in association with the pharmacological therapy the psycological group therapy could increase the IELT and ameliorate QoL of patients affected by primitive PE as showed by the decrease of PEDT score.