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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

The aim of the study is to evaluate the efficacy of Diallil-Tiosulphinate, Nuciepherine and Diosgenin in the treatment of erectile dysfunction. In our study were selected 120 men affected by erectile dysfunction. They were filled in a self-administered questionnaire International Index of Sexual Medicine. 74 of them reported a moderate erectile dysfunction and 46 reported a severe ED. All patients were treated with Tadalafil 5 mg once a day for 90 days. They were re-evaluated with the same questionnaire after three months of therapy. In 75% of the patients there was an improvement of IIEF-5 score. Only the 90 patients responders to Tadalafil once a day were randomized and divided into two groups, each formed by 45 subjects. The group A was treated with the association of Diallil-Tiosulfinate, Nucipherine and Diosgenin on alternate days. The patients of group B were treated with placebo. After three months, there was a new evaluation with IIEF-5 score. In group A we reported a maintenance of improvement post-Tadalafil in 36 patients;in group B, only 18 patients have maintained the previous improvement, according to IIEF-5 score. The χ2 test is 13,38, with a p-value of about 0,00013.The maintenance’s odds ratio, confronting the two groups, is 6 with a confidence’s interval of 95%. The study shows that the utilization of the association therapy in patients with erectile dysfunction responders to Tadalafil once a day is able to duplicate the odds of maintenance’s improvement compared to placebo.

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.

Scopo del lavoro Scopo dello studio è valutare in pz affetti da Eiaculazione Precoce (EP) il trattamento associato Farmaco+Psicoterapia di gruppo, vs Farmaco, vs Psicoterapia di gruppo in termini di aumento del Tempo di latenza eiaculatoria intravaginale (IELT) e migliore Qualità di vita (QoL). Materiali e metodi Tra gennaio e dicembre 2012 sono stati osservati tra la popolazione maschile afferita all’U.O.C. di Urologia del Policlinico P. Giaccone di Palermo 540 pz affetti da EP. Da questa popolazione selezionata è stato arruolato un campione di 270 pz secondo i criteri di inclusione: IELT ≤ a 2 minuti, Premature Ejaculation Diagnostic Tool (PEDT) ≥9, età 18-70 anni. Criteri di esclusione: disturbi psichici, malattie croniche gravi, uso di sostanze stupefacenti e abuso di alcool. I 270 pz sono stati randomizzati secondo ordine di arruolamento consecutivo in tre gruppi di 90 pz come segue: Gruppo A-Farmaco, età media 49,8 anni (range 20-68) Gruppo B-Farmaco+Psicoterapia di Gruppo, età media 49,2 anni (range 20-68) Gruppo C-Psicoterapia di Gruppo, età media 36,9 anni (range 20-56) Nel Gruppo A e nel Gruppo B è stata impiegata la Dapoxetina. I pz sono stati seguiti per 20 settimane con 4 visite ambulatoriali. Per il Gruppo B e il Gruppo C lo strumento psicoterapeutico utilizzato è stato il Gruppo Omogeneo Aperto a cadenza per 20 sedute totali. Pre e post trattamento è stato somministrato il PEDT, questionario sull’eiaculazione e sulla QoL del pz. Risultati Centoventi (44,4%) dei 270 pz arruolati non sono stati complianti alla terapia e non vi sono dati al riguardo. GRUPPO A Sessanta dei 90 pz arruolati hanno terminato il protocollo, IELT medio pre-trattamento di 79,75 sec (range 15 sec–120 sec) e punteggio medio al PEDT 15,95 (EP grave). Nel post trattamento lo IELT medio è stato di 203 sec e punteggio medio al PEDT è 8,26 (moderata EP).In 13 (21,6%) pz si è evidenziato un miglioramento del quadro clinico con punteggi medi PEDT a termine di terapia ≤ 8, e IELT riferito ≥ 2 . GRUPPO B Sessanta dei 90 pz arruolati hanno concluso il protocollo, IELT medio pre-trattamento di 74,25 sec (range 15 sec–120sec) e punteggio medio PEDT di 16 (EP grave). Nel post trattamento lo IELT medio è stato di 200 sec e punteggio medio al PEDT di 3,3 (assenza/basso livello di EP). In tutti i pazienti del Gruppo (100%) si è riscontrato miglioramento dell’EP GRUPPO C Trenta dei 90 pz arruolati hanno concluso il protocollo, IELT medio pre-trattamento di 75 sec (range 15 sec–120 sec) e punteggio medio PEDT di 15,7. Nel post trattamento lo IELT medio è stato di 186 sec e punteggio medio al PEDT di 4,03(assenza/basso livello di EP).Quindici pz (50%) hanno riportato miglioramento della EP. Discussione Il Gruppo A ha riportato miglioramenti nello IELT e nel PEDT nel 21,6% dei casi; il Gruppo B in tutti i pz (100%), mentre il Gruppo C nel 50% dei casi. Conclusioni La terapia associata si è dimostrata efficace nel trattamento dell’EP con aumento significativo dello IELT e punteggi al PEDT rientranti nel range di “normalità” al post trattamento.

Scopo del lavoro Abbiamo condotto uno studio randomizzato a singolo cieco con gruppo sham per valutare gli effetti terapeutici della TECAR terapia su 96 pazienti affetti dalla malattia di La Peyronie (IPP) vista l’efficacia di questo trattamento sulle patologie fibrose. Materiali e metodi Novantasei pazienti affetti da IPP randomizzati con rapporto 2:1 sono stati suddivisi in 2 gruppi: gruppo trattato e gruppo sham. Abbiamo valutato l’efficacia TECAR sul dolore, sul grado di incurvamento penieno e sul deficit erettile (DE) al termine del trattamento ed a 1 (FU1) e 3 (FU3) mesi dal termine del trattamento mediante l’utilizzo della scala VAS per il dolore e di questionari specifici per l’IPP e per il DE (IIEF-5). Risultati Si è registrata una riduzione statisticamente significativa del dolore nel gruppo già al termine del trattamento in 48 (75%) dei pazienti (p

Background. The value of testosterone levels and erectile dysfunction (ED) as early markers of atherosclerosis is not well understood. Objectives. To analyze the relationship between plasma testosterone levels in men with both endothelial function (F) and ED. Methods. We enrolled 802 asymptomatic, intermediate cardiovascular risk patients, according to the Framingham Risk Score, aged 40 to 80 years, who underwent the study of EF, evaluation of ED and dosage of plasma testosterone. Results. At linear regression, EF (t=9.40; 95% CI from 0.9318 to 1.4234; p

Materials and Methods. We evaluated a series of 802 patients with intermediate cardiovascular risk according to the Framingham Risk Score (FRS). The endothelial function through flow-mediated vasodilatation (FMD), the erectile function (EF), and the total serum testosterone levels were assessed. Patients were followed for up to 5 years and the prevalence and predictors of MACEs were evaluated. Results. The levels of serum testosterone are related with both endothelial function (FMD) (t=9,4080, 95% CI= 0,9318 to 1,4234, p

Scopo del lavoro Il ruolo dei livelli di testosterone plasmatico e della disfunzione erettile come marcatori precoci di disfunzione endoteliale non è ben definito. Pertanto, abbiamo cercato di analizzare la relazione tra testosterone plasmatico e disfunzione erettile, in rapporto alla funzione endoteliale. Materiali e metodi Abbiamo quindi arruolato 802 pazienti in prevenzione primaria, con una stima di rischio cardiovascolare (CV) intermedio secondo la carta del rischio di Framingham, di età compresa fra 40 e 80 anni, che si sono sottoposti all’esame ecografico della dilatazione flusso mediata dell’arteria brachiale destra, alla valutazione della disfunzione erettile attraverso il questionario International index of erectile function-5 score (IIEF-5) , e al dosaggio dei livelli plasmatici di testosterone totale. Risultati All’analisi di regressione lineare, con l’aumentare dei livelli di testosterone, aumentavano in maniera statisticamente significativa sia la funzione endoteliale (t=9.40; 95% CI da 0.9318 a 1.4234; p < 0.0001) che la funzione erettile (t=8.96; 95% CI da 0.7642 a 1.1932; p< 0,001) sia con la disfunzione erettile severa (OR 0,78; CI 0,62 -0,86), e moderata (OR 0,85; CI 0,72 - 0,97) che con una peggiore funzione endoteliale [(OR 0,68; CI 0,59- 0,79) e (OR 0,76; CI 0,63 - 0,83) rispettivamente]. Invece, le forme più sfumate di disfunzione erettile come quella lieve (OR 0.94; CI 0.82 - 1.07; p=0.03) e lieve-moderata (OR 0,8; CI 0,69 - 0,94; p Discussione Abbiamo quindi dimostrato una correlazione significativa tra livelli più bassi di testosterone plasmatico totale, disfunzione erettile ed una peggiore funzione endoteliale in una popolazione di soggetti asintomatici e a rischio CV intermedio. In particolar modo, nel sottogruppo di pazienti con disfunzione erettile moderatasevera, abbiamo visto che coloro che hanno livelli più bassi di testosterone hanno anche delle percentuali di dilatazione flusso mediata inferiori, e quindi una peggiore funzione endoteliale. Conclusioni Sulla base di questi risultati, consigliamo la valutazione della disfunzione erettile attraverso l’IIEF-5, e il dosaggio dei livelli di testosterone totale plasmatico, per ottenere una stratificazione più accurata del rischio CV nei pazienti asintomatici, ma con rischio intermedio secondo le stime della carta di Framingham.

Introduction: Does a correlation exist between smoking cessation and recurrence of non muscle invasive bladder carcinoma (NMI-BC) after TUR and adjuvant intravescical chemotherapy? Up today just few retrospective studies tried to answer this question. There is evidence that quitting decreases the risk of recurrence but nowadays it is still controversial how and how long it takes from quitting to reduce the risk (1-3). The aim of the present study is to compare the recurrence rate in smokers, non smokers and former smokers and in particular to evaluate if and how the decision of quitting at diagnosis could change the patients’outcome. Patients and Methods: We retrospectively analyzed the outcome in term of recurrence in patients affected by primary NMI-BC. Our population consisted of 373 patients, mean age of 66 (range 30-95) years. We considered as smokers the patients still smoking at the time of the diagnosis of primary NMI-BC, former smokers all the patients who quitted before diagnosis and never smokers all other patients. The smokers were divided into in current smokers continuing to smoke after diagnosis and ex smokers quitting only at diagnosis. The duration of smoking, the number of cigarettes per day and the clinical and pathological characteristic of the patients, were related to the recurrence rate. Results: Out of the 373 patients, 190 (50.9%) were smokers, 99 (26.5%) former smokers and 84 (22.5%) never smokers. Sixtyfive (17.4%) out of 190 smokers quitted at diagnosis. At 3 years 185 (49.6%) patients recurred. During follow up the recurrence rate increased from 11,3% at 3 months to 49.6% at 36 months. The recurrence rates at 3 and 6 months were higher in former smokers, 17.2% and 24.2% respectively, than in never smokers, 9.5% and 19% and smokers 9% and 21%. At one year, 75 (39.5%) smokers, 35 (35.3%) former smokers and 29 (34.5%) never smokers recurred. Among smokers at 3 months 5 (7.7%) ex smokers and 12 (9.6%) current smokers, (p=0.79) recurred; and at 6 months 13 (20%) and 27 (21.4%) recurred respectively (p=0.85). Similar results were observed at one year, with 23 (35%) ex smokers and 51 (40%) current smokers recurring (p=0.87) while at 3 years 29 (44.6%) ex smokers and 68 (54%) smokers (p=0.22) recurred. A progressive increase in recurrence rate, particularly in current smokers was observed, not reaching statistical significance due to the small numbers of our preliminary study. Discussion and Conclusion: In patients with non muscle invasive bladder cancer former smokers and smokers have similar recurrence rates. However to stop smoking at diagnosis reduces the risk of recurrence compared to patients continuing to smoke. The benefit however appears after 12 months only. References 1 Aveyard P, Adab P, Cheng KK et al: Does smoking status influence the prgnosis of bladder cancer? A systematic review. BJU Int 90: 228-239, 2002. 2 Serretta V, Morgia G, Altieri V et al: A 1-year maintenance after early adjuvant intravescical chemotherapy has a limited efficacy in preventing recurrence of intermediate risk non- muscle-invasive bladder cancer. Brit J Urol Int 106: 212-217, 2010. 3 Chen CH, Shun CT, Huang KH et al. Stopping smoking might reduce tumour recurrence in non muscle-invasive bladder cancer. BJU Int 100(2): 281-286, 2007.

Premature Ejaculation (PE) is a sexual dysfunction that concern 20-30% of the male population. Dapoxetine is a new serotonine re-uptake inhibitor (SSRI)specific for PE treatment.Aim of the study is to assess compliance and effectiveness of the treatment with dapoxetine compared to the treatment with citalopram (a classic SSRI used to treat PE).

Introduction/Aim: Numerous clinical trials investigated the association between obesity and prostate cancer, but they yielded inconsistent results (1). Obesity has been found to be related to prostatic tumors at more advanced stages and higher Gleason grade when compared with normal population (2). An increased number of biopsy cores has been advocated by some Authors in obese and overweight men due to an increased difficulty and delay in cancer detection (3). The main aim of our research was to correlate Body Mass Index (BMI) with the pathological characteristics of prostate cancer at biopsy. Patients and Methods: Patients with positive prostate biopsy performed for palpable prostate nodule and/or elevated PSA levels were considered in the present study. A transrectal prostate biopsy procedure, not less than 12 cores, was performed. The number of specimens was increased in case of re-biopsy (18-24 cores or more). After informed consent, a database has been created, including clinical and pathological data: demographics, PSA, digital rectal examination, transrectal ultrasound and prostate cancer features at biopsy. Patients were divided into four categories according to their BMI as follows: 16-19,9 (underweight), 20.0-24.9 (normal weight), 25.0-29.9 (overweight) and ≥30.0 (obese). The statistical analysis was conducted with Fisher’s exact test for Gleason pattern 4 (

Introduzione. Con lo scopo di valutare la TECAR terapia quale nuovo possibile trattamento medico della malattia di La Peyronie (PD), abbiamo condotto uno studio di fase uno senza placebo né gruppo di controllo. La TECAR terapia si basa sull’utilizzo di radiofrequenze in grado di trasferire energia ai tessuti trattati causando movimenti ionici. Ciò provoca una stimolazione cellulare in senso replicativo e riparativo. La TECAR terapia ha ottenuto risultati eccellenti nel trattamento di alcune patologie del tesuto connettivo, così abbiamo deciso di condurre uno studio circa l’applicabilità e la sicurezza della TECAR nel trattamento della PD. MATERIALI E METODI. Da giugno a settembre 2012 sono stati arruolati 70 pazienti con diagnosi clinica di PD. Ciascun paziente è stato dapprima sottoposto a visita andrologica per valutare il grado di incurvamento poi sono stati somministrati questionari per indagare circa la presenza di deficit erettile (DE) attraverso il questionario IIEF-5, lo stato di salute generale, e il dolore attraverso l’ausilio della scala VAS. Ogni paziente è stato trattato sia in modalità resistiva che capacitativa, previo consenso informato, a tre sessioni eseguite in giornate consecutive. RISULTATI. Il 100% dei pazienti ha completato il trattamento e nessuno di essi ha riportato effetti collaterali. Il 30% ha riferito un miglioramento della curvatura mentre il 60% non ha riferito alcuna modifica. Per di più i pazienti che successivamente sono stati sottoposti a Nesbit non hanno dimostrato alcuna alterazione istologica all’esame istologico. Sorprendentemente nei pazienti con PD associata a DE si è registrato un miglioramento del DE in una percentuale di casi maggiore del 60%. CONCLUSIONI. Questo è uno studio preliminare. Sulla base di questi dati si può affermare che il trattamento TECAR è fattibile. Preliminarmente sembra molto efficace nella scomparsa del dolore ma soprattutto risulta utile nel miglioramento del DE mentre sembrerebbe poco utile nel trattamento dell’incurvamento. Questo sembra suggerire la possibilità di ulteriori ricerche al fine di verificare le effettive potenzialità di questo trattamento nel trattamento della PD ma anche nel DE. Lo studio ha avuto finanziamenti: No.

Introduction/Aim: To reduce the number of negative prostate biopsies and to detect clinical significant prostate tumors in patients with elevated serum PSA represent major challenges in urological oncology. Prostate tumors diagnosed in patients with elevated Body Mass Index (BMI) show higher Gleason score and more aggressive biological behavior than those diagnosed in normal population (1). Elevated plasma levels of leptin and other adipose tissue derived factors (adipokines), are evident in obese men (2). Many studies have investigated the role of leptin as a putative molecular mediator between obesity and prostate cancer with contradictory results. Also in normal or overweight (BMI

Background: The reduction of the number of negative prostate biopsies in patients with elevated serum PSA represents a major challenge. Several angiogenetic biomarkers are involved in carcinogenesis and cancer progression. The aim of our preliminary study was to investigate if their serum levels might be related to prostate cancer detection. Patients and Methods: Angiopoietin 2, Follistatin, G-CSF, HGF, IL-8, Leptin, PDGF- BB, PECAM-1, VEGF, PTH were the selected biomarkers for our research. They were measured by BioPlex immunoassay. As a preliminary step, consecutive unselected patients undergoing prostate biopsy for palpable prostate nodule and/or elevated PSA levels were entered. A 12-core transrectal biopsy was planned. The serum levels of the above mentioned biomarkers were related with the histological result of the biopsy. ROC curve analysis was exploited to test the diagnostic accuracy of each biomarker by AUC calculation. A potential cut-off level was computed for each biomarker. Results: Thirty-five consecutive patients were entered in this preliminary study. The median PSA was 6.3 ng/ml (mean: 19.4, range 0.41-364). An altered prostate was found at digital rectal examination in 13 (37%) patients. Transrectal ultrasound gave a median prostate volume of 44.5 cc (mean 48.7; range 15-105cc). Seven patients (20%) had a previous negative biopsy and 5 were receiving dutasteride or finasteride. A median number of 12 biopsy cores was obtained (mean: 12 range 4-24). Prostate cancer was detected in 21 (60%) men. ASAP and PIN were detected in 2 more patients respectively. Among the 9 considered angiogenetic biomarkers, only leptin preliminarily shows an interesting diagnostic accuracy with an AUC of 0,714 (Table 1). At a cut-off value of 2166 pg/ml, leptin demonstrates a sensitivity of 74% and a specificity of 75% with a positive predictive value of 85%. Conclusion: Only leptin, among the 9 studied biomarkers, showed promising diagnostic accuracy for the detection of prostate cancer, suggesting the usefulness of further research.

Preme sottolineare il grande impatto sociale di molte patologie urologiche sulla popolazione, come le malattie prostatiche, l'anuria ostruttiva o l'ematuria o ancora le infezioni urinarie o il deficit erettile: non si può esercitare con coscienza la professione del medico senza conoscere le cause, i sintomi e la terapia di queste problematiche. Per tale motivo abbiamo voluto aggiornare la pubblicazione del I° vol. già pubblicato, in maniera che lo studente abbia un riferimento semplice e chiaro per preparare l'esame di Urologia, integrando i testi ufficiali.

INTRODUCTION & OBJECTIVES: Cytokines may be involved in the pathogenesis of the Peyronie's disease (PD). Cytokines levels in tunica albuginea (TA) specimens were measured by Real Time PCR in PD patients and in control group. MATERIAL & METHODS: Between January 2009 and December 2010 20 PD patients affected by PD and 8 patients affected by congenital recurvatum penis (control group) undergoing surgery were entered in the study. Routine histological examination and measurement by Real Time PCR of the expression of the encoding genes for IL-2, IL-4, IL-6, IL-10, IL-13, TGF-β1, TNF-α, IFN-γ and Metalloproteinase (MMP-2) were performed. For the normalization of data, GAPDH (glucerldehyde-3 fosfatehydrogenase) gene normally expressed in all cells was adopted. The analysis of the data was performed using the comparative method of Δct. The target gene expression were reported with the fold of induction (FOI) method calculated according to GAPDH both in PD and in control Group samples. RESULTS: The absence of inflammatory cells was demonstrated by routine histological examination in all samples. A lower median level of gene expression cytokines was detected in the PD patients when compared with the control group: IL-10 0,3864 (range 0- 1,1483), IL-2 0,089 (range 0- 0,3586), IL-6 0,0406 (range 0-0,1478), IFN-γ 0,029 (range 0-0,1187), MMP-2 0,2491 (range 0- 0,6480). IL-4, IL-13 and TNF-α were not detectable. No significant difference emerged between PD and control patients, although a trend for higher levels of TGF-β in PD patients 1,0396 (range 0,1540- 3,6432) vs 1 (control group). CONCLUSIONS: The expression of cytokines in tunica albuginea of PD patients compared to the control patients do not show any significative difference. Cytokines promoting inflammation are undetectable in PD patients and not seem to be involved in the pathogenesis of the disease. A higher level, althoug the difference was not statistically significative of the TGF- β, a profibrotic cytokine, was detected in PD patients representing a possible explain action of fibtotic tissue when the inflammation is off.

Introduction: A general awareness of the most common genitourinary diseases is often lacking.The aim of the present study was to investigate the attention of the general practitioner and of the patient to the genitourinary diseases. An incomplete medical history and/or an inadequate physical examination might be responsible of late diagnosis and improper management. Patients and Methods: A self administered questionnaire was obtained by our outpatients before the urological visit. As a preliminary step we administered a very simple questionnaire consisting of four multiple choice questions: 1) Did your general practitioner examine your external genitalia in the last five years? Did you ask for this examination? 2) Did your general practitioner prescribe any clinical investigations? 3) Have you ever seen blood in your urine? Did you advise your doctor? 4) How long time did elapse between the first symptom and our councelling? The study should be closed if less than 5 patients among the first 20 showed an improper attention to genitourinary pathology, otherwise, 200 consecutive patients at least should be entered. A further structured interview was planned in the case of doubtful results. Results: From December 2011 to February 2012, 327 questionnaires were obtained from 358 patients with a compliance of 91.3%. The median age of the patients was 61 years (range: 15-91). Two hundred fiftyfive (78%) were men. Out of 327 patients only 72 (22%) underwent a physical examination comprehensive of the external genitalia in the previous five years. The remaining 250 (76.4%) patients were not examined and, more relevant, they did not ask for. Forty-nine (63.6%) out of the 77 patients were examined on their specific request. Only 172 (52.6%) patients underwent laboratory and/or imaging assessment before urological councelling. Gross haematuria was the main urological symptom in 91 (27.8%) of cases. The general practitioner was not adviced of patients’ symptom in 13% of cases and, when informed, a urological assessment was required in only 47%. Discussion and Conclusion: Our preliminary survey point out a limited attention to the genitourinary diseases both from the general practitioner and the patient. Noteworthy, in case of gross haematuria 20% of the patients did not inform the family doctor and a urological assessment was indicated in only 50% of cases.

INTRODUCTION: The Nesbit procedure is the most common surgical technique to correct congenital or acquired penile curvature. It is a common opinion that this surgical procedure has to be completed with a circumcision to prevent foreskin necrosis or phimosis. According to our experience we believe that some procedural "tricks" could strongly reduce that mechanical and ischemic trauma on the foreskin responsible for these complications. MATERIALS AND METHODS: From 1988 to 2010 we selected 158 patients treated with Nesbit's corporoplasty. The procedure was recommended to patients who presented a penile curvature wider than 30° and reporting however some difficulty or pain at coitus, or to patients who complained about aesthetical problems (123 patients presented a La Peyronie disease and 35 presented a congenital curvature). RESULTS: Eleven patients underwent circumcision during surgery because of a pre-operative phimosis, or according to their own desire. Among the patients who did not undergo circumcision (147), paraphimosis was present in 3 patients. We reported only one case of curvature recurrence in a patient who had a sexual intercourse the day after surgery. We also had one case of hourglass effect in a congenital curvature. DISCUSSION: We believe that some tricks during Nesbit surgical procedure could prevent tissue and vascular trauma that give rise to tissue retraction, and consequently to phimosis and foreskin necrosis: a coronal incision to 0.5-1cm from the gland line would allow to let intact an adequate amount of reflection of skin (prepuce) bound of preputial skin reflection , maintaining good vascularity. The careful degloving with preparatory isolation of the dissection plan between dartos and Buck's fascia, can reduce vascular trauma of the fascia, minimizing bleeding and ensuring tissue vitality. Moreover, execution of only two hydraulics erections, after degloving and after correction, causes a minimal tissue stress. CONCLUSIONS: Circumcision must not be considered a mandatory time in Nesbit procedure: on the contrary, mandatory is the respect of the anatomical structures surgically attacked to avoid preputial resection.